37187

Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Initial Vessel

CPT 37187 describes a percutaneous transluminal mechanical thrombectomy performed on a vein or veins within an initial vessel. This procedure involves the removal of a blood clot (thrombus) using specialized mechanical devices designed to macerate, aspirate, or otherwise break down and extract the obstructive material. This is an endovascular intervention typically utilized to treat acute or subacute deep vein thrombosis (DVT) when there is a significant risk of post-thrombotic syndrome or when the thrombus is causing severe clinical symptoms such as phlegmasia cerulea dolens. Unlike purely pharmacological thrombolysis, which relies on the chemical dissolution of the clot over time, mechanical thrombectomy physically clears the vessel, often leading to immediate restoration of blood flow. The procedure includes the technical components of fluoroscopic guidance, which is used to navigate the vascular system and visualize the thrombus. It also includes the intraprocedural injection of pharmacological thrombolytic agents (bolus doses) intended to soften the clot or assist in its mechanical removal. The 'initial vessel' designation implies that this code is used for the first venous segment treated during a single operative session. If additional, distinct vessels are treated in the same setting, add-on codes would be utilized. This code encompasses the catheter placement necessary to reach the target site, the mechanical maneuvers, and the final venography performed through the thrombectomy catheter to assess the results.

Clinical Indications

  • Acute deep vein thrombosis (DVT) with high risk of limb loss
  • Subacute deep vein thrombosis causing significant symptoms
  • Failure of systemic anticoagulation to resolve venous obstruction
  • Phlegmasia cerulea dolens (painful blue edema)
  • Upper extremity venous thrombosis (e.g., Paget-Schroetter syndrome)
  • Venous outflow obstruction in hemodialysis access (though specific fistula codes may apply)
  • Prevention of post-thrombotic syndrome in active patients with extensive iliofemoral DVT

Procedure Steps

  1. Patient is positioned, and the access site (typically popliteal, femoral, or internal jugular vein) is prepped and draped.
  2. Local anesthesia is administered, and venous access is obtained using ultrasound-guided micropuncture technique.
  3. A vascular sheath is inserted over a guidewire to maintain access.
  4. Diagnostic venography is performed to identify the exact location and extent of the thrombus.
  5. A specialized mechanical thrombectomy catheter is advanced through the sheath and over a guidewire to the site of the clot.
  6. Pharmacological thrombolytics may be injected directly into the clot (bolus) to facilitate mechanical breakdown.
  7. The mechanical device is activated (utilizing methods such as rotational maceration, rheolytic saline jets, or large-bore aspiration) to fragment and remove the thrombus.
  8. Continuous fluoroscopic monitoring ensures proper placement and assesses the progress of clot removal.
  9. Follow-up venography is performed to confirm vessel patency and adequate flow restoration.
  10. The catheter and sheath are removed, and hemostasis is achieved at the access site.

Coding Guidelines

  • Code 37187 is for the initial venous vessel treated.
  • Do not report 37187 in conjunction with fluoroscopic guidance codes (e.g., 76000) as it is inclusive.
  • Includes intraprocedural pharmacological thrombolytic injections; do not report 37212 for the same vessel during the same session.
  • Catheter placement(s) necessary to perform the thrombectomy are included and should not be billed separately.
  • For treatment of a second or subsequent venous vessel, use add-on code 37188.
  • If the procedure is converted to a formal catheter-directed thrombolytic infusion lasting beyond the initial session, codes from the 37211-37214 range may be applicable, but observe NCCI edits regarding same-day procedures.
  • Do not use 37187 for arterial thrombectomy; refer to codes 37184-37186 for arterial procedures.

Associated ICD-10 Codes