Ask Dr. Z

Can you please clarify if in the femoral/popliteal territory a primary mechanical thrombectomy 37184 (diagnosis of thrombus was established prior to intervention) and an atherectomy with stent 37227 (different device used to perform) are performed if BOTH procedures can be coded (37227, 37184). There are no CCI edits with this code combination.

Our understanding is both procedures would not be coded if both are performed with the same device, but believe if separate devices are used and the mechanical thrombectomy was a “primary” thrombectomy these can both be coded. We are interpreting the NCCI Policy Manual Chapter 5 guidance to state that a SECONDARY mechanical thrombectomy (37186) CANNOT be coded with an atherectomy procedure in the same vessel, but wanted clarification as to whether this also applies to a PRIMARY mechanical thrombectomy? There is an NCCI edit with 37186 and the lower extremity atherectomy codes, but not with 37184.