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Report 36550 for declotting by thrombolytic agent

APCs Weekly Monitor, August 18, 2006

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Report 36550 for declotting by thrombolytic agent

QUESTION: Can you clarify which CPT code we should report for declotting by thrombolytic agent? For example, a patient presents with a double lumen catheter and the physician introduces a declotting agent to both lumens. Nurses wait one hour and then reintroduce the thrombolytic agent. Should we report 36550 (x4) for this encounter?

ANSWER: You are correct that you should report CPT code 36550 for this service; however, the issue here is whether you should report this code once per catheter/device or per declotting attempt per lumen.

The CPT code description reads, "Declotting by thrombolytic agent of implanted vascular access device or catheter."

Although there are no CPT Assistant guidelines that directly answer this question, Bard Access Systems- a manufacturer of the device-publishes nursing instructions that describe the nursing component of PICC insertion as one continuous service-even when a nurse makes multiple attempts to remove the occlusion.

The fact that the catheter is double versus single lumen is irrelevant based on CPT definition, as both are considered one vascular access device, regardless of the number of lumens they contain.

For your scenario above, report 36550 (x1). Bill each thrombolytic substance separately.

(The above question appeared in the August issue of HCPro's monthly newsletter, APC Answer Letter).

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