© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 37186 refers to a specific type of secondary percutaneous transluminal thrombectomy performed on noncoronary, non-intracranial arteries or arterial bypass grafts. This procedure is characterized by the use of various mechanical devices designed to effectively break up and remove blood clots that obstruct blood flow. The thrombectomy is conducted using an arterial catheter, which allows the physician to access the affected area directly. The procedure may involve different techniques, including the use of rotating wires, brushes, or hydrodynamic forces to fragment the thrombus, as well as devices such as microsnares and snare baskets to capture and retrieve the clot. During the procedure, fluoroscopic guidance is utilized to ensure accurate placement of the catheters and devices. Additionally, intraprocedural pharmacological thrombolytic injections may be administered to enhance the dissolution of the clot. It is important to note that this code is specifically used in conjunction with another percutaneous intervention, excluding primary mechanical thrombectomy, and is billed separately from the primary procedure. The complexity of the procedure and the variety of techniques employed underscore the need for precise coding to ensure proper reimbursement and compliance with billing regulations.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 37186 is indicated for the treatment of blood clots (thrombi) located in noncoronary, non-intracranial arteries or arterial bypass grafts. The following conditions may warrant the performance of this secondary percutaneous transluminal thrombectomy:
The procedure for CPT® Code 37186 involves several critical steps to ensure effective thrombectomy. The process begins with the preparation of the skin over the access artery, followed by puncturing the artery to gain access. A sheath is then placed to facilitate the introduction of catheters. Under fluoroscopic guidance, a guiding catheter is introduced into the artery. Subsequently, a microcatheter is advanced over a microguidewire and navigated through the thrombus. Once the microcatheter is in position, the guidewire is removed, allowing the mechanical thrombectomy device to be advanced through the microcatheter to the site of the thrombus. Depending on the type of mechanical device employed, the approach to breaking up the thrombus may vary. If a rotating wire or brush device is utilized, it is activated to fragment the thrombus into smaller pieces. Alternatively, if hydrodynamic forces are applied, a rapid stream of fluid is delivered to disrupt the clot, which is then aspirated to remove the debris. In cases where a retriever device is used, it is passed beyond the thrombus, deployed to capture the clot, and then retracted along with the microcatheter. Multiple passes of the mechanical device may be necessary to achieve complete removal of the clot. Throughout the procedure, a thrombolytic agent may also be injected to assist in dissolving the thrombus. Upon completion, the mechanical device, microcatheter, and guiding catheter are carefully removed from the access site.
After the completion of the secondary percutaneous transluminal thrombectomy, the patient may require monitoring for any potential complications, such as bleeding or vascular injury at the access site. The recovery process typically involves observation to ensure that blood flow is restored and that there are no adverse effects from the procedure. Patients may be advised on post-procedure care, including activity restrictions and follow-up appointments to assess the success of the intervention and monitor for any recurrence of thrombus formation. Documentation of the procedure and any administered thrombolytic agents is essential for accurate coding and billing purposes.
| Short Descr | SEC ART THROMBECTOMY ADD-ON | Medium Descr | SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 2 - 150% payment adjustment does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | ET | Emergency services | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | LC | Left circumflex coronary artery | LD | Left anterior descending coronary artery | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2016-01-01 | Changed | Description Changed |
| 2006-01-01 | Added | First appearance in code book in 2006. |
Get instant expert-level medical coding assistance.