In addition to the diagnosis code updates, there are new and revised CPT code descriptors that will be effective January 1, 2003:

CPT Code 36550

One of the difficulties encountered when working with patients that have partially or completed implanted vascular devices are the problems that result when the device becomes obstructed. CPT code 36550 (declotting by thrombolytic agent of implanted vascular access device or catheter) can be reported when it is necessary to chemically remove clot or a fibrin sheath from an implanted vascular access device. It is important to note that payment is provided under both the Medicare Physician Fee Schedule and the OPPS APC allowances for this procedure. Documentation should consist of a procedure note that includes the procedure performed, amount and type of declotting agent used, and patient tolerance of the service.

This service is generally considered to be a single bolus of thrombolytic agent, and reports declotting of partially or completely implanted devices and catheters. This procedure necessitates the use of a thrombolytic agent (e.g., Urokinase, TPA, etc.) that is introduced through a syringe and then slowly instilled into the device or catheter. Although heparin or saline prevent the formation of fibrin in the catheter tip, it is not correct to report this code for the introduction of these fluids into a port or catheter, as neither of these drugs are considered to be thrombolytic agents.

Cindy C. Parman, CPC, CPC-H
principal and co-founder of Coding Strategies, Inc. in Atlanta, GA. Cindy is a current member of the Advisory Board for the American Academy of Professional Coders (AAPC) and a faculty instructor for AMA Solutions, a subsidiary of the American Medical Association.  She serves as the Consulting Editor of the Radiology Coding Alert and is on the Editorial Advisory Board of General Surgery Coding Alert and Pain Management Coding Alert.  

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