Ask Dr. Z

Day 1 patient comes in for venogram for leg swelling. tPA is infused via the catheter for 10 minutes and thombectomy done. Thrombus is chronic and adherent, so they do multiple venoplasties. More thrombectomy thrombus is still there. No lysis catheter left in. Patient is in a lot of pain, and they discontinue the procedure. Doc states that no stent placed due to bacteremia. Adherent thrombus still present. Two days later: Angioplasty is done multiple times with multiple balloons. Then stent was placed. So, on day one, would it be a thrombolysis and thrombectomy? Or just a thrombectomy (37187)? On next procedure, would we be at a thrombectomy for the angioplasty, or would we not code a thrombectomy, as angioplasty is included in stent placement? The patient clearly still had thrombus present, and nowhere was it documented underlying stenosis. 37188 or 37187 since "ongoing thrombolysis" not done? Or just code the stent placement?