The long-term presence of access catheters in the vascular system may result in development of clot and/or fibrin within or around the catheter, causing the catheter to become non-functional. The most common complication of a semi-permanent CVC is the formation of a fibrin sheath at the tip of the catheter that causes obstruction or reduced flow through the CVC. A separately reportable venogram is performed and the existence of a fibrin sheath or other pericatheter obstructive material confirmed. The fibrin sheath or other obstructive material is mechanically removed by stripping it away with the snare.
CPT code 36595 is reported for removal of pericatheter obstructive material like fibrin sheath from central venous device.
Similarly, one more common complication of a semi-permanent CVC (Central Venous Catheter) is the accumulation of intraluminal obstructive material that causes complete occlusion or reduced flow through the CVC. A snare is used to strip away the obstructive material or the balloon catheter is inflated to open the obstruction.
CPT code 36596 is used to remove the intraluminal (intracatheter) obstructive material from central venous device.
Read also: How to become perfect in coding Vascular families in IR
Coding guide for Venous Catheterization CPT code 36010, 36011 & 36012
Code description of CPT code 36595, 36596 & 36593
36595 – Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access
Pericatheter obstructive material such as a fibrin sheath is removed from around a central venous device via separate venous access. Central venous catheters often fail because of the accumulation of an obstructing thrombus or fibrin sheath around the tip of the catheter. The catheter is first checked that it can aspirate and flush forward. The pericatheter material is identified by contrast material injection. Generally, a right femoral vein access is used. A guidewire followed by an angiographic catheter are advanced into the superior vena cava and exchanged for a loop snare with its catheter, which are advanced cephalad along the length of the central venous catheter beyond the ports. The loop snare is tightly closed about the central venous catheter to encircle it and slowly pulled down and off the tip of the catheter, stripping off the pericatheter obstructive material. This is repeated a few times and the catheter is rechecked for infusion and injection ability of the ports. A contrast study is done again to identify any fibrin and the process may be repeated until the fibrin sheath is completely removed.
For radiological supervision and interpretation, cpt code 75901 should be reported
75901 – Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation
36596 – Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen
Intraluminal obstructive material, such as a thrombus or fibrin sheath, is removed from inside a central venous device through the lumen of the device. This does not require a separate access incision. The central venous catheter is first checked that it can aspirate and flush forward. The obstructing material is disrupted and removed mechanically by using an angioplasty balloon or other catheter introduced into the central venous catheter through its entry site on the skin. The catheter is checked for unimpeded, restored flow and the process may be repeated until the central venous catheter is cleared.
For radiological supervision and interpretation, cpt code 75902 should be reported
75902 – Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation
In some cases, a thrombolytic agent, such as streptokinase, tissue-type plasminogen activator (t-PA), urokinase, or heparin, is used as to remove a thrombus (blood clot) obstructive material in implanted vascular access device (IVAD).
36593 – Declotting by thrombolytic agent of implanted vascular access device or catheter
To remove a clot from an implanted vascular access device or catheter, the physician injects a thrombolytic agent (e.g., Streptokinase) into the catheter to dissolve the clot. The patient is observed for any abnormal signs of bleeding.
Read also: Coding guide for CPT code 36245, 36246, 36247 & 36248
Do and Don’t CPT code 36595, 36596 & 36593
- Use code 36593 for thrombolytic declot of a central venous catheter. This includes “packing” the catheter with tPA or “infusing per protocol” (e.g., 1 mg/hour x four hours).
- Do not use code 36593 for routine “packing” of the catheter after an infusion therapy such as chemotherapy or plasmapheresis. This is considered a routine part of post-therapy catheter maintenance.
- Do not use code 36593 in addition to 36595 or 36596
- Both CPT code 36595 & 36596 have associated radiological supervision and interpretation codes (75901 for 36595 and 75902 for 36596), which should be separately coded to describe appropriate imaging guidance and interpretation when such services are performed.
References:
http://www.learnicu.net/Communications/Critical-Connections/
https://www.codapedia.com/article_578
http://bioportal.bioontology.org/ontologies/
