Wiki Flushing of a dialysis cath

[snordin]

We are general surgeons and we are performing flushing of dialysis patients caths on several occasions. We billed cpt cod 36593 but it is being denied by Medicare for medical necessity (dx code). I pulled up the LCD on it and it states limited coverage for this procedure and lists 9 diagnoses, which none pertain. Is there another CPT code that we should be using? Any help would be appreciated.

 

[mk2001]

I'm not sure what your diagnosis is and this is not my area but what about 96523?

 

[thomas7331]

We are general surgeons and we are performing flushing of dialysis patients caths on several occasions. We billed cpt cod 36593 but it is being denied by Medicare for medical necessity (dx code). I pulled up the LCD on it and it states limited coverage for this procedure and lists 9 diagnoses, which none pertain. Is there another CPT code that we should be using? Any help would be appreciated.

36593, per the CPT description, is not a 'flushing' of a catheter, it is 'declotting by thrombolytic agent' - in other words, the injection of a drug that would attempt to dissolve the clot. So it would be expected that this would only be appropriate and medically necessary if the catheter is clotted and requires this procedure. If that's the case, then your diagnosis should reflect this. Do you have a procedure note that says exactly what was done and why?