Ask Dr. Z

I researched the Q&A list. I have a question on a patient that had thrombus, extending from the IVC (inluding pt's IVC filter) into bilateral femoral veins and left popliteal vein. The MD did mechanical thrombectomy and thrombolysis, bilateral iliac and femoral vein angioplasty, and right common iliac venous stent. My questions are: 1)do we code for only the thrombectomy, only the thrombolysis, or both? The MD dictation states: "approximately 3mg of TPA was pulse injected via the Berenstein catheter into the thrombus within and just below the IVC filter and allowed to dwell there for the duration of the procedure (which was approx 2.5 hrs). 8Fr Trellis catheters (30cm treatment lengths) were inserted bilaterally and positioned within the vena cava just inferior to the IVC filter and extending to the left common femoral vein and the proximal right superficial femoral vein. The Trellis was activated for total 12min and 5mg TPA pulse sprayed through each catheter. Suction aspiration was performed from both catheters for approximately 60-80cc each side. Both catheters were then repositioned distally extending to the mid-SFV on the left and distal-SFV on the right (just above the sheath). The Trellis was run again for another 12min and instilling 4mg TPA on the left and 3mg TPA on the right. Aspiration was performed for an additional 60cc each side and with the Trellis motor cannula removed. Aspiration flow this time was brisk on both sides." 2)how many angioplasties are allowed? Prior to the section of the procedure quoted above, the MD states: "Balloon angioplasty was performed of both femoral and iliac veins, beginning above the sheaths and continuing to the IVC filter with a 6mm x 20cm Dorado. This was done to disrupt the fibrin crosslinking of the thrombus (given its subacute age) and allow better penetration of thrombolytic." Do we code for 4 angioplasties,or is this treated like a pre dilation and considered part of the thrombectomy or thrombolysis? Then after the completion of the thrombectomy/thrombolysis procedure, the MD also did 1 angioplasty in the right iliac for residual 70% stenosis for which I planned to code. Thank you very much for your help.