Miscellaneous Catheter Procedures ASDIN Coding University 1 Miscellaneous

Miscellaneous Catheter Procedures ASDIN Coding University 1

Miscellaneous Catheter Procedures • There are several procedures that are done only occasionally which will need to be coded – Evaluation of existing tunneled catheter – Tunneled catheter repair – Intraluminal removal of catheter thrombus – Intraluminal lytic enzyme 2

Evaluation of Existing Tunneled Catheter • There are instances in which the evaluation of an existing tunneled catheter using fluoroscopy with radiocontrast injection is medically indicated • The code for this is 36598 • The descriptor for this code is -- contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report • It is important to note that this requires image documentation 3

Column 1/Column 2 Resistrctions • 36598 is a column 2 code to several codes that might be used in conjunction with dialysis catheter management procedures • It is mutually exclusive with each of them (they cannot be used together) This list includes: – +77001 - Fluoroscopic guidance for catheter placement, replacement, or removal – 75825 - Venography, caval, inferior – 75827 - Venography, caval, superior – 75902 - Mechanical removal of intraluminal (intracatheter) obstructive material 4

Tunneled Catheter Repair • Some catheters are made with a replaceable hub; when it becomes damaged, repair of the hub may allow for the salvage of the catheter • The code for catheter repair is 36575 • The descriptor for the code is - repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump 5

Intraluminal Removal of Catheter Thrombus • If a thrombosed catheter is treated mechanically with an endoluminal brush or guidewire to remove a thrombus and restore its function the use of the code 36596 is warranted • The descriptor for this code is - mechanical removal of intraluminal (intracatheter) obstructive material from a central venous device through device lumen • If this is done under fluoroscopic guidance, there is a supervision and interpretation code to accompany it • This code is 75902. The descriptor for this code is mechanical removal of intraluminal (intracatheter) obstructive material from a central venous device through device lumen, radiologic supervision and interpretation 6

Intraluminal Lytic Enzyme • 36593 is the code for opening a thrombosed catheter using intraluminal lytic enzyme • The descriptor for this code is - declotting by thrombolytic agent of implanted vascular access device or catheter • 36593 is a column 2 code to 36596 (mechanical removal of intraluminal obstructive material from central venous device through device lumen) • The two codes can be used together with a modifier on the column 2 code • A 59 modifier should be used in this situation 7

Important Note • This document is for informational purposes only and should serve as a guideline for appropriate coding. • The ultimate responsibility for correct coding /documentation remains with the provider of service. • ASDIN makes no representation, warranty, or guarantee that this compilation of information is error-free, nor that the use of this guide will prevent differences of opinion or disputes with CMS or any other carrier. • ASDIN will bear no responsibility or liability for the results or consequences that may grow out of the use of this guidance. 8