Question: What is the difference between the two codes for clearing an obstructive vascular catheter, 36595 and 36596?
Oregon Subscriber
Answer: Both of those codes were added to CPT in 2003 to reflect the work involved in manipulating catheters blocked by fibrin sheaths.
Code 36595 (Mechanical removal of pericatheter obstructive material [for example, fibrin sheath] from central venous device via separate venous access) describes removal of pericatheter material via a separate access point. Here's how it works: The patient has a catheter that is externally clogged with a fibrin sheath. The radiologist enters the patient's body through a separate puncture, picks up a snare, snares the fibrin sheath material, and strips it off of the outside of the catheter.
Code 36596 (Mechanical removal of intraluminal [intracatheter] obstructive material from central venous device through device lumen), on the other hand, describes removal of intraluminal obstruction. During this procedure, the radiologist might take a brush and run it down through the catheter to remove the sheath that has accumulated inside the patient's catheter.
To decide which code you should report, you need to find out whether the obstructive material is inside the catheter or outside of it. If the obstruction is inside, you'll report 36596. If its outside, you'll use 36595, because the obstruction requires remote access for the physician to remove it.
