20 Jul 2017

Mechanical thrombectomy and thrombolysis coding guidelines

TRANSCATHETER PROCEDURES Thrombectomy & Thrombolysis

Mechanical Thrombectomy - Removal of the blood clot (Thrombi)

1.  Arterial Mechanical Thrombectomy
           A.  Primary (CPT 37184 – 37185)
           B.  Secondary (CPT 37186)

2.  Venous mechanical Thrombectomy (CPT 37187-37188)

Arterial Mechanical Thrombectomy

It may be performed as a primary transcatheter procedure with pretreatment planning.

CPT 37184 is used per vascular family (initial vessel treated)

CPT 37185 is for the second or all subsequent vessels within the same family.

For two or more vascular family treated append modifier 59 (Eg: 37184, 37184 – 59)

If an additional vascular family is treated through a separate access site append modifier 51 (Eg: CPT 37184, 37184 -51)

CPT 37184 – 37185 includes all intraprocedural fluoroscopic radiological Supervision & Interpretation, Injection of a thrombolytic agent.

Exception: Subsequent or prior continuous infusion of a thrombolytic agent should be reported separately (CPT 37211-37214)

Separately reportable services,
          1.  Catheter placement
          2.  Diagnostic studies
          3.  Other interventions (Balloon, stent placement)

Don’t report 37184 - 37185 performed for the retrieval of a short segment of thrombus or embolus during other percutaneous interventional procedure (Balloon or stent placement). report CPT 37186 along with the major procedure

CPT +37186 (Secondary percutaneous Transluminal Thrombectomy)

Don’t report CPT 37186 along with CPT 37184 – 37185

*For Intracranial arterial mechanical Thrombectomy – CPT 61645

*For Coronary mechanical Thrombectomy – CPT 92973

Venous Mechanical Thrombectomy

CPT 37187 – For the initial day treatment of venous mechanical 
Thrombectomy, for the bilateral procedure using separate access site – use modifier 50.

CPT 37188 – For repeat treatment on a subsequent day during a course of thrombolytic therapy – CPT 37188


Transcatheter Thrombolytic infusion: Dissolve blood clots

CPT 37211 - Initial day, arterial
CPT 37212 – Initial day, venous

CPT 37213 – Subsequent day

CPT 37214 – Final day

CPT 37211 or 37212First-day service

Included services,
          1.  Follow up arteriography / venography
          2.  Catheter position change or exchange

Note: For bilateral procedure using separate access site – use modifier 50 with 37211/37212.

Bilateral side but using same single access site – only one code

CPT 37213Continued treatment on subsequent days, This CPT should not be used on the first or last day of the therapy.

CPT 37214Final day service

Note: If the Thrombolysis treatment is completed within the same initial day – Code only 37211 or 37212, don’t use 37214.

CPT 37211 – 37214 include fluoroscopic guidance and associated S&I

Separately reportable services,
        1.  Catheter placement
        2.  Diagnostic studies
        3.  Other interventions (Balloon, stent placement)

E&M with Thrombolysis therapy
        1.  Related E&M is included
        2.  Unrelated E&M would be billed with modifier 25

Ultrasound guidance for vascular access is not included in 37211 – 37214 hence CPT 76937 would be reported separately.

Note: Percutaneous Thrombectomy includes intraprocedural Thrombolysis procedure; hence don’t use CPT 37211- 37214 along with Thrombectomy.  If Thrombolysis is performed 60 min continuous before or after Thrombectomy then append modifier 59 with Thrombolysis.

    Any other intervention procedure like angioplasty or stent placement before, during or after infusion therapy should be billed separately.

    There is no time limit for infusion therapy still injection is not an infusion. Never report infusion CPT codes for transcatheter bolus or injection of a thrombolytic agent.

For declotting by a thrombolytic agent of implanted Vascular access device or catheter – CPT 36593


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