# 2 tunneled dialysis catheter exchanges same day



## rebeccadyke84 (May 7, 2013)

Hello, 
Can I code 36581 twice? Here is what my doc did:

I am asked to exchange both of the patient's tunneled dialysis catheters (one in the right internal jugular vein and one in the left femoral vein) as apparently, the patient has had multiple difficulties with various tunneled dialysis catheters and his using both of these devices in one manner or another to accomplish dialysis.

The right internal jugular catheter insertion site was anesthetized with local anesthesia and using traction and blunt dissection, the cuff was released from the tunnel. A stiff Amplatz guidewire was advanced through the catheter into the inferior vena cava (to the right atrium) and the catheter was removed. The wire cleansed and a new catheter was advanced and then positioned with the tip at the entrance to the right atrium as the stylets and guidewire were removed. 

Attention was then turned to the left femoral catheter and similar technique was used to replace this catheter as well. Both catheters were then secured with silk ligature to the skin and dress appropriately.

1. Successful exchange of the right internal jugular venous tunneled dialysis catheter.
2. Successful exchanged of the left femoral venous tunneled dialysis catheter.

thanks


----------



## Cyndi113 (May 8, 2013)

Can't see why you wouldn't be able to bill both. He/she did the work and documented.


----------



## dimmitta (May 13, 2013)

Yes you can bill 36581 twice in this case. Clearly the catheters were in two separate locations. You will need to bill the second one with a 59 modifier but it does meet the guidelines to use one here. If you are also using fluoroscopic guidance in this case bill 77001 ( but can only bill this once).


----------

