2. Miscellaneous Catheter Procedures ASDIN Coding University 1

3. 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

4. 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

5. Column1/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

6. 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

7. 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

8. 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

9. 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