Ask Dr. Z

Patient presents for planned atherectomy about one week after percutaneous angio. Spider distal protection device was placed. Injection of contrast revealed string sign. SilverHawk device is advanced, “which went though the lesion very easily. For this reason, I decided against initiating the procedure with atherectomy and instead I proceeded with mechanical thrombolysis to remove any soft material or thrombus that may be present... The AngioJet device was then used through the SAME popliteal lesion removing a significant amount of thrombus.” After another injection of contrast, SilverHawk is used for atherectomy in the same vessel. Would you code this thrombectomy as primary 37184 because an AngioJet was used for a significant amount of thrombus? Or, would you code it as secondary 37186 because it was unanticipated and removal of clot was needed before the planned atherectomy?