October 2014 Q & A

Question: Venous Stent Placement During Thrombolytic Therapy

In the 2014 Interventional Radiology Coding Reference, page 196 example #2, there is a thrombolytic therapy procedure that ends with a venous stent placement. The venous stenting codes do not include the catheter placement, and according to the CPT manual, you should report those in addition to the stents (37238-37229). The example only has the 37238 and does not list a catheter placement CPT code. The thrombolytic catheter is removed and a new catheter for the stent placement is inserted. Other coding references have stated that if a new catheter is placed even from the same access, you would report the catheter placement for the intervention. Wouldn’t you report the venous catheter placement in this example? And if so, what code would you use?

Answer:

The catheter placement would be included in the first date of service for thrombolysis. If the catheter (thrombolytic catheter in this case) had already been in place, you cannot code another catheter placement for placing a different catheter (stent catheter) to the same location. That would be double coding, and Medicare has examples that specifically exclude billing another catheter placement in this situation. (See the 2014 National Correct Coding Initiative (NCCI) Manual for Medicare Services, Chapter 5, pp 5-6)