# 35476 vs 36595 - Fibrin sheath obstruction removal during IJ dialysis cath exchange



## jennifer.r.wake (Dec 28, 2015)

I am having some difficulty determining whether to code 36595+75901 or 35476+75978 for the case below (I know the 36581 and 77001 needs to be coded). My understanding is that, even though we are using a balloon to disrupt the fibrin sheath obstruction, we would not be able to code 35476+75978 (angioplasty) unless a stenosis is documented and requires PTA to treat.


Procedures:
After informed consent was obtained, the patient was taken to the interventional suite, and sterilely prepped and draped in the usual fashion. Local anesthesia was provided with 1% Lidocaine with epi. The cuff was bluntly dissected free from the subcutaneous tissues and the enveloping fibrin sheath, and extracted. Guide wire access was obtained into the IVC. An angiogram of the SVC was then completed, demonstrating an obstructive fibrin sheath in the SVC. The sheath obstruction was greater than 60%. 10mm PTA was performed in the SVC to relieve the obstruction. A new 36cm Ash Split catheter was then placed over guide wire and positioned in the right atrium under direct fluoroscopic guidance. Both ports pull and flush easily. The catheter is fixed to the chest wall with 0-Neurolon suture. 

Estimated Blood Loss: 5ml 
Amount of Radiocontrast used: 10ml 
Fluoro time: 1:33 minutes:seconds 

Impressions: Successful removal and replacement of left IJ tunneled cuffed dialysis catheter. Fibrin sheath obstruction post PTA of the SVC.



I appreciate any feedback!


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## amandamkcj (Jan 18, 2016)

You are correct to use 36595 75901 as removal of fibrin around the cath device is reported with those codes. You would want to add a 52 modifier when sep venous access is not performed/documented. You would also want to check CCI edits with the other CPT codes you are capturing for this case as well.
Amanda CIRCC RCC


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## akila.p (Feb 1, 2016)

*36595,75901*

36595-52,75901 is the correct coding for this report


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