How To Use CPT Code 37186

CPT 37186 describes the procedure for secondary percutaneous transluminal thrombectomy, which involves the removal of small sections of a thrombus or embolism from a noncoronary or non-intracranial arterial occlusion or from an arterial bypass graft. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 37186?

CPT 37186 is used to report the procedure for secondary percutaneous transluminal thrombectomy. This procedure involves the removal of small sections of a thrombus or embolism from a noncoronary or non-intracranial arterial occlusion or from an arterial bypass graft. It is performed in conjunction with another percutaneous intervention, such as stent placement or balloon angioplasty. The procedure includes fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections.

2. Official Description

The official description of CPT code 37186 is: ‘Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure).’ It is important to note that CPT code 37186 should not be reported in conjunction with codes 76000 and 96375, and should not be reported with code 61645 for treatment of the same vascular territory.

3. Procedure

1. The physician performs a percutaneous intervention, such as stent placement or balloon angioplasty, to address the arterial occlusion or bypass graft.
2. After the primary procedure, the physician identifies the presence of a thrombus or embolism that needs to be removed.
3. The physician inserts a catheter and advances it to the site of obstruction through a guide wire.
4. Using various methods under fluoroscopic guidance, the physician breaks up the clot using a sharp mechanical device or high-speed water-jet.
5. If necessary, the physician administers thrombolytic injections to further dissolve the clot.
6. The remnants of the clot are then suctioned out through the catheter.

4. Qualifying circumstances

CPT code 37186 is used when the physician performs a secondary percutaneous transluminal thrombectomy in conjunction with another percutaneous intervention, such as stent placement or balloon angioplasty. The procedure is performed on noncoronary, non-intracranial arterial occlusions or arterial bypass grafts. It is important to note that CPT code 37186 should not be reported with codes 76000 and 96375, and should not be reported with code 61645 for treatment of the same vascular territory.

5. When to use CPT code 37186

CPT code 37186 should be used when the physician performs a secondary percutaneous transluminal thrombectomy in conjunction with another percutaneous intervention, such as stent placement or balloon angioplasty. It is important to ensure that the procedure is performed on noncoronary, non-intracranial arterial occlusions or arterial bypass grafts. CPT code 37186 should not be reported with codes 76000 and 96375, and should not be reported with code 61645 for treatment of the same vascular territory.

6. Documentation requirements

To support a claim for CPT code 37186, the physician must document the following information:

• Indication for the secondary percutaneous transluminal thrombectomy
• Details of the primary percutaneous intervention performed
• Fluoroscopic guidance used during the procedure
• Intraprocedural pharmacological thrombolytic injections administered
• Documentation of the removal of the thrombus or embolism
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 37186, it is important to ensure that the procedure is performed in conjunction with another percutaneous intervention, such as stent placement or balloon angioplasty. CPT code 37186 should not be reported with codes 76000 and 96375, and should not be reported with code 61645 for treatment of the same vascular territory. It is important to review the explanation of benefits (EOB) carefully for claims with add-on codes to ensure proper reimbursement. Add-on codes should not be reduced for multiple procedure discounts unless specified in a contract.

8. Historical information

CPT code 37186 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Examples

1. A physician performs a percutaneous transluminal angioplasty (PTA) to address an arterial occlusion, and during the procedure, identifies the presence of a thrombus that needs to be removed. The physician performs a secondary percutaneous transluminal thrombectomy (CPT 37186) to remove the thrombus before completing the PTA.
2. After a stent placement procedure, the physician identifies the presence of an embolism in the arterial bypass graft. The physician performs a secondary percutaneous transluminal thrombectomy (CPT 37186) to remove the embolism.
3. During a percutaneous intervention for an arterial occlusion, the physician encounters a thrombus that complicates the procedure. The physician performs a secondary percutaneous transluminal thrombectomy (CPT 37186) to remove the thrombus before continuing with the intervention.