Oncology & Hematology Coding Alert

Question: I know I can't report vascular access device flushing on the same date as chemotherapy, but what if the staff uses tPA to declot a vascular device? May I report that service separately? How should I code multiple injections?

California Subscriber

Answer: You may report the vascular device declotting using tPA (tissue plasminogen activator) on the same date as chemotherapy administration. For the declotting service, you should report 36593 (Declotting by thrombolytic agent of implanted vascular access device or catheter). Note that use of a thrombolytic agent, such as the tPA you mention, is required for this code.

Distinction: CPT® Assistant (December 2009) indicates that the 36593 service is not the same as routine flushing of a vascular access device using saline or heparin. As you note, routine flushing is included in the chemotherapy service and is not separately reportable.

Multiple injections: If staff administers multiple thrombolytic injections for a single declotting service, you should not report 36593 multiple times. On the other hand, if the vascular device requires separate declotting more than once on the same date, you may report 36593 for the first service and then report each additional service using 36593-59 (Distinct procedural service).

Support: CPT® Assistant states, 36593 "should only be used multiple times when defined separate declots take place." Documentation should clearly show the initial declotting was successful and then, subsequent to the initial declotting, a separately defined clot occurred requiring another round of tPA to declot again.