Erica Posted Wed 21st of March, 2018 11:36:12 AM
I need help - my coding department says this TPA (37187) is not code-able and in my eyes I think it is. This doctor then removes the IVC filter as below. Can you please give me your opinion on this?
Erica Ross CIRCC, RCC
Kumpe catheter was then placed over exchange length stiff Glidewire into the
left lower extremity. Left lower extremity venogram was performed with
hand-injection DSA images confirming some collaterals with minimal filling
defect in the distal superficial femoral vein and popliteal vein. This was
followed by placement of 4 mg of TPA within mechanical infusion device for 30
minutes. Post TPA thrombolysis left lower extremity no residual acute defect
seen. Patent collaterals are noted. The catheter was removed over wire.
Through the sheath a snare was placed. This was followed by placement of a
snare, and the snare was used to gain access into the existing IVC filter
hook. IVC filter was tilted by approximately 40 degrees to the left. Multiple
attempts were made using clover stent as well as the gooseneck stent without
success. This was followed by placement of a dilator over wire. 12 French as
well as 14 French dilator followed by placement of a 16 French sheath.
Through 16 French sheath a SOS Omni catheter was advanced over a wire
surrounding the medial aspect of the left IVC filter. A Glidewire was then
advanced through the catheter. The wire was then snared into the sheath. The
same was repeated in a cross-sectional matter within the IVC filter.
Additional wire was also advanced and snared into the sheath. This was
followed by placement of a sheath over the IVC collapsing the struts. The
filter was removed successfully with fluoroscopic guidance. IVC filter
removal venogram demonstrates no thrombus. The sheath was then removed and
pressure was applied for hemostasis. The patient tolerated the procedure
well. There were no complications.
SuperCoder Answered Thu 22nd of March, 2018 07:38:12 AM
CPT 37187 is for percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, in which the provider accesses the femoral or popliteal vein and performs a separately reportable venography by injecting contrast material through the incision into the vein, to localize the exact site of the clot in the vein. Then under fluoroscopic guidance, he inserts a guidewire to the site of occlusion and then threads a catheter over the guidewire. He further dissolves the clot through a single or multiple injection of a thrombolytic agent. Whereas, in your case, placement of 4 mg of TPA within mechanical infusion device for 30 minutes has been performed, which is not appropriate to bill as a code of 37187. On the other hand, CPT code range 37211-37214 is for the transcatheter therapy for thrombolysis specifically for arteries and veins by infusion. Out of which CPT 37212 if most appropriate code to bill for venous infusion for thrombolysis, in this procedure, the provider initially reach out to affected vessel under fluoroscopic guidance and advances a catheter with an infusion tip inside the vessel with the help of a guidewire. He then infuses a thrombolytic drug at the site of the clot to dissolve the clot. So, check the complete op-report to select the appropriate code.
As per provided documents, the suggested code is not buddle with IVC filter removal, hence can be billed together.