Radiology Coding Alert

Question: Which CPT and ICD-9 codes should I report when the physician mechanically strips a fibrin sheath from a central venous device through a separate puncture, under imaging guidance, to remove the obstruction?


Oklahoma Subscriber

Answer: If the radiologist performed both the fibrin sheath removal and the radiological supervision and interpretation, you should report 36595 (Mechanical removal of pericatheter obstructive material [e.g., fibrin sheath] from central venous device via separate venous access) and 75901 (Mechanical removal of pericatheter obstructive material [e.g., fibrin sheath] from central venous device via separate venous access, radiologic supervision and interpretation).

The diagnosis code for this procedure could be either 996.73 or 996.74. Use 996.73 (Other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to renal dialysis device, implant, and graft) when the fibrin sheath involves a vascular catheter used for hemodialysis.

And submit 996.74 (Other complications of internal [biological] [synthetic] prosthetic device, implant, and graft; due to other vascular device, implant, and graft) for fibrin sheath of other vascular catheters.

Don't: You can't report 36550 (Declotting by thrombolytic agent of implanted vascular access device or catheter) with 36595, according to CPT guidelines. When a provider simply injects a thrombolytic in the catheter to dissolve a clot, that's when you'd report 36550.

Caution: Don't confuse 36595 and 36596 (Mechanical removal of intraluminal [intracatheter] obstructive material from central venous device through device lumen). You would report 36596 for mechanical removal of intraluminal obstructive material from a central venous line through the central device lumen. Example: The physician uses a guidewire or brush to loosen and then aspirate the obstruction.