How To Use CPT Code 36904

CPT 36904 describes the percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36904?

CPT 36904 can be used to describe a procedure in which a healthcare provider uses fluoroscopic guidance to introduce a catheter into a vessel in the dialysis circuit. The provider then performs a mechanical thrombectomy and/or infusion for thrombolysis, which involves removing a blood clot or injecting a drug to dissolve the clot. This procedure also includes diagnostic angiography and radiological supervision and interpretation.

2. Official Description

The official description of CPT code 36904 is: ‘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).’ It is important to note that CPT 36904 should not be reported in conjunction with CPT codes 36836 and 36837, and for open thrombectomy within the dialysis circuit, different codes should be used (36831 and 36833).

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. Using fluoroscopic guidance, the healthcare provider introduces a catheter through the skin over a surgically created connection between an artery and a vein in the dialysis circuit.
3. The provider injects contrast material to visualize the circulation throughout the arterial and venous components of the dialysis circuit.
4. If a clot is identified, the provider uses various methods or devices to break up and retrieve the clot, such as coils, aspiration, or stent retrieval devices.
5. Alternatively, the provider may inject a thrombolytic agent to dissolve the clot and suction out the debris with an aspiration unit.
6. The provider withdraws the catheter after confirming that the clot has been completely removed.
7. Pressure is applied over the access point to control bleeding.
8. The provider supervises the angiography procedure and interprets the findings.

4. Qualifying circumstances

CPT 36904 is performed on patients who require percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit. This procedure is typically done for patients with a clot in the vessels comprising the dialysis circuit. The patient must have a surgically created connection between an artery and a vein, such as an arteriovenous graft, fistula, or anastomosis. The procedure requires the use of fluoroscopic guidance, diagnostic angiography, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s). It is important to note that CPT 36904 should not be reported with certain other codes, as specified in the official description.

5. When to use CPT code 36904

CPT code 36904 should be used when a healthcare provider performs percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit. This code is appropriate when the procedure includes all the necessary components, such as imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s). It is important to review the official description and guidelines to ensure accurate usage of this code.

6. Documentation requirements

To support a claim for CPT 36904, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit
• Details of the procedure, including the use of fluoroscopic guidance, diagnostic angiography, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)
• Date and duration of the procedure
• Specific techniques and devices used during the procedure
• Findings from the angiography and radiological interpretation
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 36904, ensure that the procedure includes all the necessary components as described in the official description. It is important to review the guidelines and any specific instructions regarding reporting this code with other related codes. For example, CPT 36904 should not be reported with CPT codes 36836 and 36837. Additionally, there are separate codes for open thrombectomy procedures on the dialysis circuit (36831 and 36833). It is crucial to accurately follow the billing guidelines to ensure proper reimbursement.

8. Historical information

CPT 36904 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs percutaneous transluminal mechanical thrombectomy in the dialysis circuit to remove a clot using fluoroscopic guidance and diagnostic angiography.
2. Using a combination of mechanical thrombectomy and pharmacological thrombolysis, a provider successfully treats a patient with a clot in the dialysis circuit.
3. A healthcare provider performs percutaneous transluminal mechanical thrombectomy and infusion for thrombolysis in the dialysis circuit, using various devices and techniques to remove the clot.