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Penumbra Thrombectomy with Atherectomy

Date: Jun 18, 2021


Our physician performed HawkOne atherectomy and Penumbra thrombectomy in the same SFA artery. In one case the thrombectomy was performed first in the other it was performed after the atherectomy. He states, "occlusion likely composed of thrombus and thrombectomy performed to minimize risk of distal embolization". Can the thrombectomy be coded if he didn't state there was actual thrombus retrieved? If we query the physician and he states there was thrombus retrieved how do we determine if this is a primary or secondary arterial thrombectomy? Medicare has denied billing a secondary thrombectomy 37186 with atherectomy 37225 even with an unbundling modifier for a separate device used. We would really appreciate your opinion on how you would code these cases.

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