Ask Dr. Z

"An Angioseal was placed for arterial closure following a Y-90 embolization, but it became displaced. This resulted in distal embolism and thrombosis of the right lower extremity. The radiologist proceeded to snare and remove the Angioseal from the right profunda artery (37197), and then via a separate access proceeded to first inject tPA into the right anterior tibial artery and then perform angioplasties of both the right anterior tibial, the tibioperoneal trunk, and the posterior tibial arteries."  Since it sounds like the angioplasties were used in conjunction with the tPA injection to treat the iatrogenic occlusion, would this be considered secondary thrombectomies of the anterior and posterior tibial arteries (37186 x 2), or would we use the lower extremity revascularization angioplasty codes 37228 and 37232?