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Mechanical IVC Thrombectomy

Phyllis Posted Tue 21st of January, 2014 19:24:26 PM

Our anesthesiologist was told there is no CPT for Mechanical IVC thrombectomy via rt. internal jugular and rt. femoral, including IVC to femoral cardiopulmonary bypass utilization. I need both the CPT and ASA codes.

Interventional radiology report
Using ultrasound guidance using seldinger technique a 21 g micropuncture needle was used to access the rt. internal jugular, rt. femoral and lt. femoral veins. 6 fr sheaths subsequently placed in the rt. internal jugular and bilateral femoral accesses. Contrast injected simultaneously through bilateral sheaths, digital subtraction images of the bilateral common iliac veins and inferior vena cava demonstrate infrarenal IVC thrombus extending just slightly into the bilateral common iliac veins.

A hydrophilic wire was advanced through the rt. internal jugular sheath and passed through the infrarenal IVC thrombus.

The rt. internal jugular vein was serially dilated with placement of a 26 fr dry-lock sheath. The lt. femoral access was serially dilated with placement of an 8 fr sheath. The rt. femoral access was serially dilated with placement of a 17 fr sheath. A vascular bypass circuit was constructed between the rt. IJ sheath and the rt. femoral sheath continually monitored by the perfusionist. The Angiovac device was advanced through the rt. sheath. Subsequent venous vacuum thrombectomy commenced.

Thrombectomy contrast was injected through the lt. femoral sheath. Digital subtraction images demonstrate persistent infrarenal IVC thrombus and narrowing of the lt. common iliac vein. The lt. common iliac narrowing was angiioplastied to 10mm and 12mm. Thrombectomy was again conducted. Follow-up lt. sheath angiogram demonstrates improved but persistent thrombus. Through the lt. femoral sheath the IVC was angioplstied to 16mm.

SuperCoder Answered Wed 22nd of January, 2014 16:36:03 PM

CPT for venous mechanical thrombectomy only would be 37187.

The ASA (American Society of Anesthesiologists) lists 01930 as the primary anesthesia code associated with 37187. The descriptor does include the note of "not to include access to the central circulation," but I think that's talking about the anesthesiologist, not the surgeon. So, it should be OK for the anesthesiologist to report.

I'm curious why you want both codes for the procedure and anesthesia. If the physician performing the procedure also administered anesthesia, you should only code for the procedure. CCI edits bundle the services and state that anesthesia is included.

Phyllis Posted Tue 28th of January, 2014 16:29:00 PM

Although we submit only anesthesia codes to insurance, we look up the CPT codes in the Crosswalk to arrive at those codes. In case your response was an unlisted CPT, I asked you to also provide the ASA code.

SuperCoder Answered Wed 29th of January, 2014 12:46:43 PM

We recommended a surgical CPT code of 37187 and noted that it crosses to anesthesia/ASA code 01930. If the person asking the question doesn't believe that 01930 is most appropriate, alternate ASA codes for 37187 are 01931, 01932, and 01933. The physician's documentation should help point the coder to the best choice.

I hope that helps,

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