Ask Dr. Z

From H&P: "Woman with PMHx s/f PAH, pulmonary emboli (PAH thought to be out of proportion, Eliquis) here for PA angiogram." PMH lists CTEPH (chronic thromboembolic pulmonary hypertension) and pulmonary embolism. Cath report states: "Pulmonary artery angioplasty. Right heart catheterization. 60-year-old female with PMH of CTEPH referred for BPA #1. RHC performed with findings (93451). Sheath into right pulmonary artery. Selective angiography (93568). CTEPH treatment: Right lung A9 web lesion and A10 subtotal occlusion. Lesions in A9 subsegmental branch and A10 segmental branch were serially dilated with balloons, restoring flow distally with improved pulmonary venous drainage." How should this be coded: as a pulmonary angioplasty with 92997/92998 (LCD Article A56365 states I27.24 CTEPH is a covered diagnosis) or as thrombectomy with 37184? If patient's have CTEPH, would we code angioplasty because they have stenoses/narrowing of their pulmonary arteries as webs, bands, occlusions form, or would we code as maceration of clot/organized thrombus? (Patient not covered by Medicare.)