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Wiki Hemodialysis catheter pulled out by patient

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Looking for some feed back. Patient pulled out the tunneled hemodialysis catheter (NO PORT WAS EVER PLACED). The physician simply replaced the tunneled catheter. Looking at CPT's 36580 or 36558. Cannot use the 36578 for catheter replacement only as it states WITH port or pump.

Any thoughts????
 
If it was a tunneled catheter w/o port or pump, would you not be able to use 36581 with a 52 modifier?
 
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