Summary & Overview

CPT 37187: Mechanical Thrombectomy with Pharmacologic Thrombolysis

CPT code 37187 covers endovascular treatment of venous occlusion using a combined mechanical thrombectomy and pharmacologic thrombolytic injection, performed under fluoroscopic guidance. Nationally, this code represents a high-acuity, image-guided vascular intervention used to restore venous patency in acute or subacute thrombotic occlusions. Its appropriate use affects hospital resource allocation, interventional radiology and vascular surgery workflows, and payer coverage decisions.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 37187, common sites of service, and the service type. The publication summarizes billing and coding considerations, payer coverage patterns, and benchmarking where available. It also highlights relevant policy updates and coding guidance impacting reimbursement and documentation for fluoroscopically guided mechanical thrombectomy with thrombolytic administration.

This executive summary equips clinical billing teams, revenue cycle leaders, and policy analysts with the essential framework to understand where CPT code 37187 fits within vascular intervention services and payer landscapes at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37187CPTmechanical thrombectomyvenous thrombolysisendovascularinterventional radiologyfluoroscopyvascular surgeryhospital outpatient

Billing Code Overview

CPT code 37187 describes a combined mechanical thrombectomy with pharmacologic thrombolytic injection to treat an occlusion in a vein. The procedure includes the use of fluoroscopic guidance while performing mechanical thrombectomy to remove or disrupt thrombus and deliver thrombolytic agent directly.

Service type: Endovascular venous thrombectomy with pharmacologic thrombolysis
Typical site of service: Hospital outpatient department or inpatient interventional radiology/vascular suite where fluoroscopic imaging and endovascular equipment are available

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with a history of deep venous thrombosis (DVT) and new-onset worsening limb swelling, pain, and decreased distal perfusion after recent orthopedic surgery. Venous duplex ultrasound demonstrates extensive iliofemoral thrombus with limb-threatening symptoms and elevated risk for post-thrombotic syndrome. The interventional radiology or vascular surgery team evaluates the patient and consents for an endovascular procedure: combined mechanical thrombectomy with localized pharmacologic thrombolytic infusion under fluoroscopic guidance (37187).

Pre-procedure workflow includes review of coagulation studies, renal function, and imaging (venography or CT venography as indicated). The patient is brought to an angiography suite or hybrid operating room. Vascular access is obtained (typically common femoral or popliteal vein access), baseline venography is performed, and a multi-modality approach is used: mechanical thrombectomy device to remove bulk thrombus plus catheter-directed infusion of a thrombolytic agent (for example, tissue plasminogen activator) into the residual clot, all under fluoroscopic guidance. Procedural documentation includes indications, access site, devices and thrombolytic agent used, fluoroscopy time, contrast volume, intra-procedural complications, and post-procedure plan for monitoring and anticoagulation. Typical post-procedure care occurs in a post-anesthesia care unit or monitored inpatient bed for surveillance of bleeding and thrombolysis effect, with follow-up duplex imaging and adjustment of systemic anticoagulation as indicated.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
`2080S00000X`	Vascular Surgery	Commonly performs endovascular venous interventions and thrombectomy procedures.
`2084P0800X`	Interventional Radiology	Frequent operator for image-guided mechanical thrombectomy and catheter-directed thrombolysis.
`207RP1001X`	Surgery - Cardiovascular (Vascular)	Vascular specialists involved in complex venous reconstructions and thrombectomy.

ICD-10 Code	Description	Clinical Relevance
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of left lower extremity	Acute iliofemoral DVT causing limb symptoms and potential indication for combined mechanical and pharmacologic therapy.
`I82.402`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	Same clinical relevance for the right limb.
`I82.403`	Acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities	Bilateral extensive DVT where bilateral `37187` application may be considered.
`I82.409`	Acute embolism and thrombosis of unspecified deep veins of lower extremity, unspecified laterality	Used when laterality is not specified in documentation.
`I82.89`	Other venous embolism and thrombosis	Covers less common venous thromboses (for example pelvic or iliac) that may require endovascular thrombectomy and thrombolysis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36010`	Introduction of needle or intracatheter, vein; for diagnostic or therapeutic purposes, not otherwise specified	Used to obtain venous access or for initial diagnostic venography prior to performing `37187`.
`36215`	Selective catheter placement, arterial system; iliac, femoral, or popliteal angiography (note: arterial code often appears in peripheral angiography workflows)	May be performed when concurrent arterial assessment is needed or to document arterial anatomy in limb ischemia evaluation associated with venous thrombosis.
`37184`	Endovascular mechanical thrombectomy, percutaneous, venous, including fluoroscopic guidance, when performed alone	Reported when mechanical thrombectomy is performed without concurrent pharmacologic thrombolytic infusion; `37187` represents the combined technique.
`37211`	Transcatheter therapy, infusion, chemo, percutaneous or open, not elsewhere classified (example infusion codes vary)	When prolonged catheter-directed infusion systems are used for thrombolytics, infusion-related codes or facility billing for infusion time may be relevant.
`49405`	Insertion or replacement of peritoneal dialysis catheter (example unrelated code)	Data not available in the input.

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