Targeting the Complexities of Thrombolysis Coding

Catheter-directed thrombolysis is a powerful tool in the fight against dangerous blood clots, delivering a clot-busting agent right where it’s needed—in a vein or artery. Whether used on its own or alongside other treatments, this procedure can make all the difference in restoring healthy blood flow. Picture a catheter being expertly guided to the exact spot of the clot, where it releases a dissolving agent like tissue plasminogen activator (tPA) to do its work overtime. Thrombolysis can take hours or even days to complete, depending on the severity of the clot, and the AMA has developed codes to cover these varying time frames, ensuring accurate coding for these life-saving treatments. Coding in the area can remain extremely complex. With the potential payment cuts at the start of next year, the value of every reimbursement dollar cannot be underestimated. Let’s break down some of the nuances for full-proof accurate coding.

Transcending Thrombolysis Coding Details

First, understand that codes 37211 and 37212 do NOT include catheterization, diagnostic angiograms, or other interventions. Codes for those services should only be added when appropriate. CPT® describes conditions for coding a diagnostic angiogram S&I during the same session as an intervention. Code 76937 for ultrasound guidance for vascular access may also be coded when performed and documented according to code description requirements. 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, regardless of how many times the patient is brought back for follow-up. Be aware that you should not assign 75898 for follow-up angiography during thrombolytic infusions.

Coders should note that the thrombolysis codes are unilateral, so if bilateral thrombolysis is performed through separate accesses, add modifier 50 to the appropriate code. Modifiers continuously prove to be a challenging area for coders, resulting in widespread billing errors, so knowing how to apply the correct modifier is especially important. With that in mind, be careful that if two completely separate vascular beds, such as the renal artery and femoral artery, are treated, you should 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.

Be vigilant about the circumstances when the code should be not applied. 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.

When coding for thrombolysis, it’s important to know which codes to assign for different treatment scenarios. For the initiation of thrombolysis and any same-day follow-up evaluations, imaging, or catheter repositioning/exchanges, use codes 37211 or 37212. Code 37211 is specific to arterial thrombolysis, while 37212 is used for venous thrombolysis. If the procedure starts and finishes on the same day, you’ll only report the initial treatment day using the appropriate code. This distinction is key for ensuring accurate billing and documentation when managing thrombolysis cases.

Under the circumstances 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. Removal of the catheter and closure of the access site are included in 37214.

Discover vital expert insight today that will reinforce your revenue for 2024 and beyond!

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 Venous Studies Interventional Radiology Coding live on October 16, 2024 at 11:00 am, or on demand past this date. This webcast is an essential training tool for both audio and visual learners.