How To Use CPT Code 36905

CPT 36905 describes the 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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36905?

CPT 36905 can be used to describe a procedure that involves the percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit. This procedure includes all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s). Additionally, it includes transluminal balloon angioplasty in the peripheral dialysis segment, along with all necessary imaging and radiological supervision and interpretation for the angioplasty.

2. Official Description

The official description of CPT code 36905 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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty.’

3. Procedure

1. The provider begins by introducing a catheter into a vessel in the dialysis circuit under fluoroscopic guidance.
2. Using special instruments, the provider performs percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis to extract a blood clot or inject a drug to dissolve the clot.
3. The provider then identifies a narrowed segment in the peripheral dialysis segment and proceeds with transluminal balloon angioplasty.
4. During the angioplasty, the provider inserts a balloon through the catheter into the narrowed area and expands it to open up the vessel lumen.
5. After confirming that the vessel is open, the provider withdraws the catheter and applies pressure to control bleeding at the access point.
6. The procedure also includes diagnostic angiography and radiological supervision and interpretation to visualize the circulation throughout the arterial and venous components of the dialysis circuit.

4. Qualifying circumstances

CPT 36905 is performed on patients who require percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit. This procedure is suitable for patients with blood clots or obstructions in their dialysis circuit. The provider must use all necessary imaging and radiological supervision and interpretation, perform diagnostic angiography, provide fluoroscopic guidance, place catheters, and administer intraprocedural pharmacological thrombolytic injections. The procedure also includes transluminal balloon angioplasty in the peripheral dialysis segment.

5. When to use CPT code 36905

CPT code 36905 should be used when the provider performs percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis in the dialysis circuit, along with transluminal balloon angioplasty in the peripheral dialysis segment. This code should not be reported in conjunction with CPT codes 36836, 36837, or 36904.

6. Documentation requirements

To support a claim for CPT 36905, the provider must document the following information:

• Patient’s diagnosis necessitating the procedure
• Details of the percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis
• Specific imaging and radiological supervision and interpretation performed
• Diagnostic angiography findings
• Fluoroscopic guidance details
• Catheter placement(s) and technique used
• Intraprocedural pharmacological thrombolytic injection(s) administered
• Transluminal balloon angioplasty procedure and its outcomes
• Confirmation of vessel patency
• Documentation of any complications or adverse events
• Provider’s signature

7. Billing guidelines

When billing for CPT 36905, ensure that the procedure includes all the necessary components, such as percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, diagnostic angiography, fluoroscopic guidance, catheter placement(s), intraprocedural pharmacological thrombolytic injection(s), and transluminal balloon angioplasty in the peripheral dialysis segment. Do not report CPT 36905 in conjunction with CPT codes 36836, 36837, or 36904. It is important to follow the specific guidelines provided by the payer and use appropriate modifiers if required.

8. Historical information

CPT 36905 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 patient with a blood clot in their dialysis circuit undergoes percutaneous transluminal mechanical thrombectomy and transluminal balloon angioplasty to restore blood flow.