Your ZHealth Coding Newsletter for January 2006
 
Coding Question:  
Help please. Is there anything we can charge for the angiojet thrombectomy performed during thrombolytic therapy follow up? On page 126 of your 2005 IR Coding Reference, Item #21 says these treatments are coded as infusion thrombolysis 37201.  However, since we started TPA the previous day and this intervention was done during ongoing TPA therapy, is it still proper to charge 37201 again? We have had two of these cases in the last week. On one the angiojet treatment was successful, one it wasn't. Also, if the catheter is selectively place in a vessel of a higher order, during the catheter exchange, can we charge for further selectivity?

Procedure:  Follow up lt lower extremity arteriography, status post thrombolysis, angioplasty intragraft stenosis, and mechanical thrombectomy. Contrast injection was performed via the thrombolysis catheter.....Decision was made to treat the distal graft stenosis...Repeat arteriography was performed focusing on the distal graft anastamosis in oblique projections. This confirmed the presence of a 60% stenosis in the distal graft.  An 8 x 20 mm balloon was advanced over the wire and position at the level of the graft stenosis and inflated.  Postangioplasty follow up arteriogram demonstrated improved appearance of the stenosis.  A fragment of adherent thrombus was dislodged from the graft wall and seated at the distal graft anastomosis.  A tiny thrombus fragment embolized to the bifurcation of the anterior tibial artery and tibioperoneal trunk.  Neither thrombus fragment was flow limiting. In order to help preserve the patency of the graft, decision was made to attempt clearing of the nonocclusive thrombus.  The angiojet was swept through the area of thrombus twice.  Post angiojet arteriography demonstrated no significant change in appearance of the thrombosed fragments, and continued excellent outflow via the trifurcation vessels. Attempts at suction thrombectomy were performed.  However, the fragment could not be removed by this method
 
Dr Z's Coding Answer:
If thrombolysis is performed over multiple days, only code a total of one 37201/75896, even if started, stopped and restarted and continued over multiple days.  Thrombectomy with Angiojet, Oasis, Trerotola devices or other thrombectomy devices now have 5 new codes available for use percutaneously in the arteries and veins.  The codes in the venous system are used for the initial date of treatment (37187) and a separate code for additional days of venous treatment (37188).  On the arterial side, there are two codes (37184 and 37185) for primary thrombectomy procedures, and 37186 is used for secondary thrombectomy procedures.  The case below sounds like a case of secondary thrombectomy as after the intended procedure (thrombolysis, angioplasty) resulted in a fragment of clot that was attempted to be extracted with a suction embolectomy and thrombectomy device.  This was not the intended procedure but a secondary procedure. 
 
The 2006 Edition of Dr Z’s Medical Coding Series: Interventional Radiology Coding Reference
 
 
  • New 2005 and 2006 code changes
  • New chapters on Percutaneous Thrombectomy & Neurovascular Interventional procedures
  • New codes for intracranial intervention, urologic intervention, kyphoplasty, etc. procedures
  • New, and expanded examples
  • New and updated coding sheets
  • New Terminology section
…and much more
 
 
Order Your 2006 Edition
of Dr Z’s Medical Coding Series: Interventional Radiology Coding Reference today
and get a free copy of the 2005 Edition