CPT® Code 36860

1. Indications

The external cannula declotting procedure (CPT® Code 36860) is indicated for patients who present with an occluded external cannula due to thrombus formation. The following conditions may warrant this procedure:

• Occlusion of External Cannula The presence of a thrombus that obstructs blood flow through the external cannula, necessitating intervention to restore patency.
• Need for Vascular Access Patients requiring continued vascular access for hemodialysis or other medical treatments where uninterrupted blood flow is critical.

2. Procedure

The procedure for external cannula declotting without a balloon catheter involves several key steps to effectively address the occlusion:

• Step 1: Examination and Palpation The physician begins by examining the external cannula and palpating it to assess the site of occlusion. This step is crucial for determining whether the blockage is due to a thrombus.
• Step 2: Digital Manipulation If a small thrombus is identified, the physician attempts to remove it through digital manipulation. This involves physically manipulating the cannula to dislodge the clot, which may help restore blood flow.
• Step 3: Administration of Thrombolytic Agent If digital manipulation alone is insufficient, the physician may inject a thrombolytic agent to aid in dissolving the thrombus. This agent can be administered using a pulse-spray technique or through a lyse-and-wait method, where a small amount is injected and allowed time to act on the clot.

3. Post-Procedure

After the declotting procedure is completed, the physician will evaluate the effectiveness of the intervention by assessing blood flow through the external cannula. It is important to monitor the patient for any signs of complications or recurrence of occlusion. The physician may provide specific post-procedure care instructions, which could include recommendations for monitoring the cannula site and ensuring proper maintenance to prevent future clots. Follow-up appointments may be scheduled to reassess the cannula's patency and overall function.