Wiki 37211 Infusions

[ablythe]

I am coding a report that says, "A 5F infusion catheter was placed in the popliteal
artery and 6 mg of Reopro was infused distally followed by 200 mcg of
intra-arterial nitroglycerin." My physician used the 37211 code for arterial infusion for thrombolysis. I do not think I can use the infusion code simply because an infusion catheter was used and the physician said he infused these drugs. What additional information do I need from him? My memory tells me that we can use this code if the "infusion" lasted an hour or longer, but I do not know where I got that idea.

Can anyone provide guidance on this issue?

Thank you,

Allison, CPC, CCC

 

[jtuominen]

Allison--

Reopro is a platelet aggregation inhibitor that could be used to treat a thrombus and break it down inside someone's diseased vessel, so its possible that a thrombolytic infusion was performed.

The highlights you need to look for in the report and the patient's work up are the following:

1. First determine what the primary procedure plan was for the patient's visit. Does the patient's latest consult note or H&P relate that the patient maybe had an abnormal ABI and plan is to have the patient come to the IR lab for angiogram and possible intervention? Does the workup indicate thrombolysis as possible primary treatment modality?

2. Next review your operative note, what does the indication for the procedure read? If there is a history contained within the operative note, what does it state? If you are seeing thromboyltic therapy mentioned, your probably headed toward 37211. Also if there was a diagnostic study performed prior to intervention, what did the provider find? Thrombus?

3. You are right that thrombolytic therapy can be used more like a supportive treatment -- sometimes docs will inject a little nitro, TPA or other thrombolytic agent down a vessel, to help the vessel dilate and to help break up the clot, all in anticipation of really performing a mechanical thrombectomy. Usually these short little infusions are only for a few minutes. So the adage goes that if the primary treatment modality is thrombolysis, you'll probably be seeing that drug infuse for at least 30 minutes, or more likely, they are going to leave the lab with the infusion still running and go back to their room for a while.

If you see these hallmarks, then you're provider was probably trying to use thrombolysis as a primary treatment modality, and 37211 sounds appropriate.

The other thing you can always do is just run over to your lab or call you doctor and just ask him or her what their intended treatment plan was if its still not clear.

You could also post the deidentified note here too and Im sure someone will have a look at it.

 

[ablythe]

Thank you so much!

Allison