In terms of coding of lower-extremity deep vein thrombosis (DVT) thrombolysis, is there a difference between mechanical thrombolysis and pharmacologic thrombolysis?
Lower-extremity DVT thrombolysis can be a complex procedure to code appropriately. There are a number of factors to consider. Specifically, was pharmacological and mechanical thrombolysis performed? Was a diagnostic venogram performed? Was ultrasound guidance used for venous access? Were there subsequent days of thrombolysis? Was venous stenting or angioplasty performed?
On the first day, 76937 can be reported for ultrasound access into the vein. Assuming wire and catheter are used to traverse the thrombus and gain access into the inferior vena cava (IVC), 36010 should be reported for catheter access into the vena cava. If mechanical thrombolysis/thrombectomy is performed, 37187 is reported. Of note, 37187 includes intraprocedural thrombolytic infusion and fluoroscopic guidance. If an infusion catheter is left in place at the end of the procedure, 37212 should be reported. Additionally, if diagnostic venography is performed (which requires an interpretation in the final report), 75820 can also be reported. Finally, if percutaneous venous angioplasty or venous stenting are performed, then these are also separately reportable.
Each subsequent day that thrombolysis treatment is continued without termination, 37213 should be reported. 37213 includes follow-up catheter contrast injection, and position change or exchange, if performed. If mechanical thrombolysis/thrombectomy is performed on subsequent days, 37188 should be reported.
On the final day of thrombolysis, code 37214 should be reported. 37214 should not be reported together with 37212 or 37213 for the same day of service. 37214 includes cessation of thrombolysis, removal of catheter and vessel closure.
How should I report embolization of a congenital venous malformation?
Code 37241 is used to report vascular embolization and occlusion procedures for nonhemorrhagic venous conditions. This includes use of sclerosants (e.g., sotradecol, alcohol, etc.), as well as other traditional embolics (e.g., particles, glue, etc.). The CPT manual specifically states that examples of diseases that qualify for use of code 37241 include venous malformations, capillary hemangiomas, varicoceles and visceral varices. Code 37241 includes all radiological supervision and interpretation, roadmapping and imaging guidance. Embolization (or other ablative techniques) of incompetent lower-extremity veins and skin telangiectasias or spider veins are not reported with code 37241; rather, codes 36468–36479 should be used to report these services.
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