Arts Council of Clinton
Published on August 20, 2014
American Society of Diagnostic & Interventional Nephrology – Fall 2014 Newsletter DRAFT 1 Coding Decoded: Removal of Trombus Not Associated with Trombosed Access By Gerald Beathard, MD, PhD Case History: MM is a 56 year old male with a loop grat in his let arm. Te grat is 4 years old and has thrombosed 5 times. When the patient arrived at dialysis on Friday, he was not able to dialyze because his access was thrombosed. He was sent to the hospital or management. At the hospital his potassium was ound to be 7.4. A temporary catheter was placed in the let internal jugular vein. Te patient was dialyzed and sent home with the catheter in place. Te patient arrives 2 days later at the access center or management. On examination it was ound that his access grat in the let arm did not have any ow. Tere was no evidence o inection. Ater obtaining inormed consent, the patient was taken to the procedure room or a thrombectomy and removal o the temporary catheter. Te temporary catheter was removed without difculty. During the course o the angiographic evaluation o the central veins, it was discovered that the patient had a thrombus in the let brachiocephalic vein. Tis thrombus was removed using an 8 French aspiration sheath. Te thrombectomy procedure which required an angioplasty at the venous anastomosis was successul. Ater the patient had recovered rom sedation he was discharged to the dialysis clinic. Coding: In addition to the thrombectomy procedure that was perormed on this patient’s dialysis access. A thrombus was removed rom a vein some distance rom the access. Tis thrombus was separate rom the thrombosed access and was not directly related. Its removal warrants a separate code. Te appropriate code or use here is 37187. Te descriptor or this code is percutaneous transluminal mechanical thrombectomy, vein(s), including intra-procedural pharmacological thrombolytic injections and uoroscopic guidance. Te code 37187 is a column 1 code to 36870 (thrombectomy) and is mutually exclusive; however, it does allow use with a modier. In the scenario described above, this code should have a 59 modier attached to indicate that it is a separate procedure. Basically, this code can be used in 2 types o situations. Te rst is as described here. In this instance, it is critically important that the procedure documentation clearly indicates that the thrombus being treated was totally separate rom the thrombosis within the access. It cannot be an embolus rom nor can it be an extension o the thrombus within the access. Te second situation in which this code could be used is when a thrombus is present but the access is not thrombosed, ow is present. In this instance, the use o the thrombectomy code would not be appropriate since the access is still unctional. Tis is an in situ thrombus. Te same situation would hold or any vessel. Occasionally, this situation also occurs within an artery. In this instance the code 37184 should be used.