Summary & Overview
CPT 37188: Repeat Mechanical Thrombectomy with Pharmacologic Thrombolysis
CPT code 37188 designates a repeat endovascular procedure combining mechanical thrombectomy with pharmacologic thrombolytic infusion for venous occlusion on a subsequent day of ongoing thrombolytic therapy. This code captures care when the treating clinician returns to perform additional thrombectomy under fluoroscopic guidance as part of a multi-day thrombolysis course. Nationally, procedures addressing acute venous thromboembolism and catheter-directed thrombolysis are high-cost, resource-intensive services delivered primarily in hospital inpatient and hospital outpatient interventional suites, making accurate coding important for clinical documentation, utilization tracking, and payment adjudication.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical setting for CPT code 37188, plus an outline of what to expect in benchmarking and policy context: national utilization and payment benchmarks where available, common billing considerations, and the clinical circumstances that support use of this repeat endovascular thrombectomy code. Data not available in the input will be noted as such in detailed tables. The content is aimed at billing professionals, clinical leaders, and policy analysts seeking a clear, national-level summary of this specific CPT code and its clinical role in multi-day thrombolytic therapy.
Billing Code Overview
CPT code 37188 describes a repeat session of combined mechanical thrombectomy and pharmacologic thrombolytic infusion to treat an occlusion in a vein during the course of ongoing thrombolytic therapy. The procedure is performed on a subsequent day of thrombolytic treatment and includes use of fluoroscopic guidance for the mechanical thrombectomy portion.
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Service type: Endovascular combined mechanical thrombectomy with pharmacological thrombolysis (repeat procedure during thrombolytic course)
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Typical site of service: Hospital inpatient or hospital outpatient interventional radiology or vascular surgery suite, using fluoroscopic imaging guidance
Clinical & Coding Specifications
Clinical Context
A typical patient is a hospitalized adult with an acute deep venous thrombosis (DVT) of the iliofemoral or femoropopliteal venous segments who is undergoing catheter-directed thrombolytic therapy and requires a subsequent-day repeat of combined mechanical thrombectomy and thrombolytic infusion. The patient presents with progressive limb swelling, pain, and limited mobility despite initial catheter-directed thrombolysis performed on a prior day. The vascular interventional team evaluates venography and ultrasound findings showing persistent or recurrent intraluminal thrombus. Under moderate sedation or general anesthesia in an interventional radiology or hybrid vascular suite, the interventionalist uses fluoroscopic guidance to perform mechanical thrombectomy to macerate and remove clot and administers pharmacologic thrombolytic agent through a catheter on the subsequent day of an ongoing thrombolytic regimen. The clinical workflow includes pre-procedure coagulation assessment, vascular access (commonly femoral or popliteal), baseline venography, mechanical thrombectomy with aspiration or device-assisted clot disruption, continued localized thrombolytic infusion as ordered, repeat venography to document flow restoration, and post-procedure monitoring for bleeding and reperfusion. Documentation should note the date of the prior thrombolytic session, rationale for repeat combined mechanical and pharmacologic therapy, fluoroscopic guidance, access site, medications and doses, and any complications or adjunctive interventions (for example, stent placement) that could affect coding or billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |