January 2015 Q & A

Question: 37186 - Secondary Mechanical Thrombolysis

What is your opinion of coding 37186 as add-on with 37225 when thrombus is identified and documented in the primary atherectomy site, not in distal anatomy? Single rotational/aspiration device is used.


In your example, we would not recommend submitting 37186 for incidental thrombus treated with the same single device at the site of the atherectomy procedure (for treatment of the stenosis). IF separate devices are utilized, first to remove thrombus and identify an underlying stenosis, then to perform an atherectomy, I would code for both. If a single device is utilized to perform both atherectomy and thrombectomy at the same site at the same session, I would only submit the atherectomy. IF the entire vessel is thrombosed (such as a femoral/popliteal bypass graft) and a primary thrombectomy is performed, then an underlying stenosis is identified and treated with atherectomy after the thrombectomy (based on imaging after the thrombectomy), I would consider 37184 followed by the atherectomy 37225 regardless of device. This last example is very unusual and would have to be extremely well documented to support both codes. As a routine, we do NOT recommend atherectomy and thrombectomy treatment at the same site with the same device.