Noridian is providing coding clarification and advice for reporting percutaneous mechanical removal of a venous thrombus embolized to the central cardiopulmonary circulation, including the right heart and central pulmonary vessels.
The review of medical records indicates procedure code 37184, 37185 and 37186 are being billed incorrectly and do not support the medical necessity for treatment of a venous pulmonary thrombus. 37187-37188 should be used for these services.
Percutaneous Venous Mechanical Thrombectomy is coded for reporting as CPT 37187 (Percutaneous transluminal mechanical thrombectomy, including intraprocedural thrombolytic injections with fluoroscopic guidance). Consideration is made to the origin of the thrombus traveling as an embolus to the central circulation but originating in the venous return portion of the systemic vasculature.
This procedure is most commonly reported for suction thrombectomy of the thrombus or embolus, in addition to the injection of thrombolytic agents under fluoroscopic guidance, as the initial treatment for pulmonary embolus causing cardiac strain and hypoxia (cor pulmonale.)
A second or repeat procedure is not uncommonly required for removal of additional or remaining thrombus on the following day, and/or the delivery of additional pharmacological thrombolytics. Indications are the continued signs and symptoms of cardiopulmonary compromise. This should be coded as CPT 37188 when performed on the day following the date of service of the initial procedure.
Both CPT 37187 and 37188 may be reported with the modifier -50, signifying thrombectomy of both Right and Left branches of the main pulmonary artery or branches of the artery on each side, having undergone removal of thrombus. Standard reimbursement for bilateral procedures applies if the procedure is reported twice on the same day or is performed in more than one branch of the main pulmonary artery. Both CPT 37187 and 37188, with or without the -50 modifier, may be reported only once per calendar date of service.
Neither CPT 37187 nor 37188 include vascular access which should be reported separately. Fluoroscopic guidance is included in the code descriptor for both CPT 37187 and 37188 so should not be separately reported. Do not report 96375-76 or 76000 with either CPT 37187 or 37188, per CPT coding guidelines and descriptor inclusions.
Diagnosis codes of ICD-10 I26.0x are expected for procedure to diagnosis editing, signifying the medical necessity of cardiopulmonary compromise by the Pulmonary Embolus treated by the procedures 37187 and 37188. The use of ICD-10 diagnosis code of I26.9x may be appropriate with substantial documentation of compromise to the cardiopulmonary status of the Beneficiary and may be requested by the Contractor or other CMS Contractors (e.g., Recovery Audit Contractor, Supplemental Medical Review Contractor) to establish medical necessity of the procedure.