Comprehending Catheter-Directed Thrombolysis with Actionable Examples in 2024

Upper extremity coding is an area with many complications and opportunities for errors. Thrombolysis is one service that our experts have targeted for review. Catheter-directed thrombolysis is a critical medical procedure involving the direct introduction of an agent into an artery or vein to dissolve blood clots. This technique, which can be performed either before, after, or as a stand-alone procedure, involves guiding a catheter to the thrombosis site and infusing a lytic agent, such as tissue plasminogen activator (tPA), over an extended period. Given that thrombolysis procedures often extend beyond a single day, the American Medical Association (AMA) has introduced specific codes to address these varying time frames. This month, we will explore the nuances of coding for catheter-directed thrombolysis, ensuring accurate and comprehensive medical billing for success in 2024.

Capturing Knowledge of the Nuances

First, it is important to know what these codes do not encompass. Codes 37211 and 37212 do NOT include catheterization, diagnostic angiogram, and other interventions. Coders must identify when it is appropriate to add these codes based on the services performed. Another key consideration is that CPT describes conditions for coding a diagnostic angiogram S & I at the same session as an intervention. Code 76937 for ultrasound guidance for vascular access also may be coded when performed and documented according to code description requirements. Understand that when it comes to E & M , E & M visits to the patient on the day of, and related to, thrombolysis are included and not separately coded.

The following codes are assigned per calendar day and include all imaging and catheter repositioning and/or exchanges required on that day. This remains true regardless of how many times the patient is brought back for follow-up. Coders should not assign 75898 for follow-up angiography during thrombolytic infusions.

The thrombolysis codes are unilateral, so if bilateral thrombolysis is performed through separate accesses, add modifier 50 to the appropriate code. If two completely separate vascular beds, such as a renal artery and femoral artery, are treated, add modifier 59 to the appropriate thrombolysis codes.

Although not specifically noted in the CPT® manual, when these codes were introduced during the CPT Symposium, AMA speakers indicated that these thrombolysis infusion codes are to be assigned for prolonged infusions: The patient must leave the treatment room with the infusion running.

Do not assign a thrombolysis infusion code for an injection of a thrombolytic agent during a mechanical thrombectomy procedure. Do not report the following codes for intracranial arterial thrombolysis, see code 61645 instead.

Assign codes 37211 or 37212 for initiation of thrombolysis and any subsequent follow-up evaluation, imaging, and/or catheter repositioning or exchanges on the same day. Report the initial treatment day of arterial thrombolysis with code 37211 and the initial treatment day of venous thrombolysis with code 37212.

The timeframe when the service is performed can be an extenuating scenario. When thrombolysis ends on the same day that it starts, assign only the initial treatment day code.

When a thrombolysis procedure lasts three or more days, each day except the initial day and the last day should be reported with code 37213. It may be assigned for either arterial or venous thrombolysis, and it includes any work related to the thrombolytic procedure on the same calendar day.

The last day of a thrombolysis procedure is reported with code 37214. As with 37211, 37212, and 37213, this code is assigned per calendar day, and includes:

• any follow-up exams
• catheter repositioning
• and/or exchanges.

Note that removal of the catheter and closure of the access site are included in 37214.

Expert Examples in Action

The following two examples demonstrate the use of these codes.

EXAMPLE 1

Day 1

1:00 p.m Left common femoral artery is catheterized from a right groin access, and a diagnostic left lower extremity angiogram is performed. Based on the findings, the decision was made to begin thrombolysis in the popliteal artery. The catheter was maneuvered to the left popliteal and thrombolysis was initiated.

5:00 p.m. The patient is brought back for a follow-up angiogram, and thrombolysis is resumed.

Day 2

8:00 a.m. The patient is brought back for a follow-up angiogram. The decision was made to perform mechanical thrombectomy in the popliteal. The thrombolysis catheter was removed, suction thrombectomy performed, and a new thrombolysis catheter was

placed. Thrombolysis was resumed.

4:00 p.m. The patient is brought back for a follow-up angiogram. Thrombolysis was stopped,

catheter was removed, and a closure device was deployed.

Codes assigned:

Day 1: 36247, 75710-59, 37211

Day 2: 37214, 37186

EXAMPLE 2

Day 1

1:00 p.m. The left common femoral artery was catheterized from a right groin access, diagnostic left lower extremity angiogram was performed. Based on the findings, decision was made to begin thrombolysis in the popliteal artery. The catheter was maneuvered to the left popliteal, and thrombolysis was initiated. 5:00 p.m. The patient is brought back for a follow-up angiogram and thrombolysis resumed.

Day 2

8:00 a.m. The patient is brought back for a follow-up angiogram. The decision was made to perform mechanical thrombectomy in the popliteal. Thrombolysis catheter was removed, suction thrombectomy performed, and a new thrombolysis catheter was placed. Thrombolysis was resumed.

4:00 p.m. The patient is brought back for a follow-up angiogram. Thrombolysis was resumed.

Day 3

8:00 a.m. The patient is brought back for follow-up angiogram. Thrombolysis was resumed. 12 Noon The patient is brought back for follow-up angiogram. Catheter is repositioned. Thrombolysis was resumed.

4:00 p.m. The patient is brought back for follow-up angiogram. Thrombolysis was discontinued, catheter was removed, and closure device was deployed.

Codes assigned:

Day 1: 36247, 75710-59, 37211

Day 2: 37213, 37186

Day 3: 37214

These are NOT all the tips and tricks necessary to tackle upper extremity interventional radiology coding.

As service volumes rebound and every dollar of reimbursement counts more than ever in the face of payment cuts, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics and break down the complexity with our expert-infused 2024 2024 Upper Extremity Interventional Radiology Codinglive on August 7, 2024

at 11:00 am CT or on demand past this date. This webcast is an essential training tool for both audio and visual learners.