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PULMONARY ANGIOGRAM

Janet Posted Wed 22nd of January, 2014 10:40:53 AM

jUDKINS DIAGNOSTIC CATHETER WAS USED TO INSERT TO THE MAIN PULMONARY ARTERY, PULMONARY ANGIOGRAPHY WAS DONE. THIS REVEALED SIGNIFICANT PULMONARY EMBOLI IN THE MAIN PULMONARY ARTERY. PRESSURES WERE MEASURED AND SHOWED PULMONARY ARTERY PRESSURE WAS TO BE 155/20. AT THAT TIME , 20 MG OF TPA WAS INJECTED SLOWLY OVER 2 MINUTES. MECHANICAL THROMBECTOMY WAS DONE USING ANGIOJET, MULTIPLE PASSES WERE USED TO THE MAIN PULMONARY ARTERY, LEFT PULMONARY ARTERY AND THE RIGHT PULMONARY ARTERY . THE CATHETER WAS THEN REMOVED. IVC VENOGRAM WAS DONE TO IDENTIFY THE RENAL VEINS. IVC FILTER WAS THEN PLACED. WOULD 75743.26, 37191, AND 37211 BE THE CORRRECT CODES? THANKS

SuperCoder Answered Wed 22nd of January, 2014 15:28:22 PM

Pulmonary angiography note refers only to the main pulmonary artery, so this appears to be 75746-26-59 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation). This code is bundled with thrombectomy code 37184. 75746 should only be coded if it’s for a truly diagnostic angiogram (decision to perform thrombectomy was based on this angiography, etc.)

There is documentation of mechanical thrombectomy using Angiojet, so this appears to be 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel) and +37185 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure))

Note that those above codes include intraprocedural thrombolytic injections.

And then as you noted, for IVC filter placement, use 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed).

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