Upper extremity coding is a sea of complexity that can easily sink coding accuracy if you are not prepared. Thrombolysis, in particular, poses a high risk for costly mistakes if not coded with precision. Our experts have targeted catheter-directed thrombolysis as a top priority for review. This essential procedure, which involves infusing a lytic agent directly into an artery or vein to break up clots, can span multiple days and take various forms—before, after, or independent of other interventions. To address this complexity, the AMA has assigned specific codes based on timing and duration. This month, we are exploring coding examples that break down common scenarios, complete with coding assignments and rationale for advancing comprehension.
The following two examples demonstrate the use of these codes.
Day 1
1:00 p.m. Left common femoral artery is catheterized from a right groin access, and a diagnostic left lower extremity angiogram is performed. Based on the findings, the decision was made to begin thrombolysis in the popliteal artery. The catheter was maneuvered to the left popliteal and thrombolysis was initiated.
5:00 p.m. The patient is brought back for a follow-up angiogram, and thrombolysis is resumed.
Day 2
8:00 a.m. The patient is brought back for a follow-up angiogram. The decision was made to perform mechanical thrombectomy in the popliteal. The thrombolysis catheter was removed, suction thrombectomy performed, and a new thrombolysis catheter was placed. Thrombolysis was resumed.
4:00 p.m. The patient is brought back for a follow-up angiogram. Thrombolysis was stopped, catheter was removed, and a closure device was deployed.
Codes assigned:
Day 1: 36247, 75710-59, 37211
Day 2: 37214, 37186
Day 1
1:00 p.m. The left common femoral artery was catheterized from a right groin access, diagnostic left lower extremity angiogram was performed. Based on the findings, decision was made to begin thrombolysis in the popliteal artery. The catheter was maneuvered to the left popliteal, and thrombolysis was initiated. 5:00 p.m. The patient is brought back for a follow-up angiogram and thrombolysis resumed.
Day 2
8:00 a.m. The patient is brought back for a follow-up angiogram. The decision was made to perform mechanical thrombectomy in the popliteal. Thrombolysis catheter was removed, suction thrombectomy performed, and a new thrombolysis catheter was placed. Thrombolysis was resumed.
4:00 p.m. The patient is brought back for a follow-up angiogram. Thrombolysis was resumed.
Day 3
8:00 a.m. The patient is brought back for follow-up angiogram. Thrombolysis was resumed. 12 Noon The patient is brought back for follow-up angiogram. Catheter is repositioned. Thrombolysis was resumed.
4:00 p.m. The patient is brought back for follow-up angiogram. Thrombolysis was discontinued, catheter was removed, and closure device was deployed.
Codes assigned:
Day 1: 36247, 75710-59, 37211
Day 2: 37213, 37186
Day 3: 37214
As noted above, the thrombolysis codes are unilateral (or separate vascular bed). There could be situations where separate thrombolysis procedures are begun in separate extremities or vascular beds and one is discontinued before the other. Each procedure should be coded separately. One example (see example 1 below) would be if arterial thrombolysis is begun on Monday in both legs, discontinued on Tuesday in the left leg, but continued until Wednesday in the right leg. Another example (see example 2 below) would be venous thrombolysis begun on Monday in the right leg, discontinued on Tuesday in the right leg, but begun in the left leg, with discontinuance on Wednesday.
According to the AMA, each of these would be coded in the following way.
Codes assigned:
Example 1:
Monday: 37211-50
Tuesday: 37214-LT, 37213-RT
Wednesday: 37214-RT
Example 2:
Monday: 37212-RT
Tuesday: 37214-RT, 37212-LT
Wednesday: 37214-LT
NOTE: CMS has NCCI edits that preclude billing 37211 or 37212 with 37213 or 37214 and edits
precluding billing 37213 and 37214 together. Bilateral services with modifier 50 are allowed and will be paid at 150 percent of the Medicare physician fee schedule (assuming medical necessity requirements are met).
All four of these codes have an MUE of 1 per day with an MUE adjudication indicator (MAI) of 2.
This means that Medicare will not pay for the same code twice on the same day unless billed on one line with modifier 50. If billed with modifier 59 or with modifiers RT and LT, all line items with those codes will be denied. A Medicare contractor may not over-ride the MUE unless it is following a post-appeal directive issued by a qualified independent contractor (QIC) or ALJ.
⚠️ Your 2025 IR Coding Remains Under Threat, Creating Significant Risk to Your Bottom Line. These Are NOT All the Tips and Tricks Necessary for Success.
With every dollar of reimbursement counting more than ever in the face of payment decline and complex changes, it’s imperative to make sure your CPT® coding is correct and compliant. Master more coding topics and break down the complexity with our 2025 Upper Extremity Interventional Radiology Coding live on August 6, 2025 at 11:00 am CT (120 minutes) or on demand past this date. This webcast is an essential training tool for both audio and visual learners.
I had planned a different topic for this week, sequencing sepsis, based on feedback from my last article, but an article about OpenEvidence rolling out
EDITOR’S NOTE: The author of this article used artificial intelligence (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
Please log in to your account to comment on this article.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Stacey Shillito, CDIP, CPMA, CCS, CCS‑P, CPEDC, COPC. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
