Cardiology Coding Alert

Question: The cardiologist used fluoroscopic guidance to introduce a catheter through the skin over an arteriovenous graft, which was the dialysis access point. He injected contrast material to visual the circulation throughout the arterial and venous components of the dialysis circuit. He then injected a thrombolytic agent to break down a blood clot that was compromising the dialysis circuit. The cardiologist used an aspiration unit to suction out the debris, and then withdrew the catheter after he ensured that he had completely removed the clot. The cardiologist supervised the procedure and interpreted his findings. Which code should I report for this service?

Alabama Subscriber

Answer: You should report 36904 (Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)) for percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit.

Caution: Code 36904 includes diagnostic angiography (36901), fluoroscopic imaging guidance, catheter placement, radiological supervision and interpretation, and any maneuvers the cardiologist used to remove the thrombus from the peripheral and/or central segments, according to the CPT^® guidelines. These maneuvers include all intraprocedural pharmacological thrombolytic injections or infusions the cardiologist uses.

Don’t miss: You should only report 36904 for a percutaneous transluminal mechanical thrombectomy. If you needed to report an open thrombectomy within the dialysis circuit, you would instead look to codes 36831 (Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)) and 36833 (Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)), per CPT^®.