AHA Coding Clinic® for HCPCS - 2012 Issue 2; Ask the Editor
Removal of a Fibrin Sheath under Fluoroscopic Guidance
The removal of a fibrin sheath under fluoroscopic guidance with the use of a balloon catheter is reported with CPT codes 36595, Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, or 36596, Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, and their respective radiological supervision and interpretation codes 75901, Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation, or 75902, Mechanical removal of intraluminal (intracatheter), obstructive material from central venous device through device lumen, radiologic supervision and interpretation. We are questioning whether modifier 52, Reduced Services, needs to be appended because all of the components of the codes were not performed. According to the code narratives for CPT codes 36595 and 75901, a separate venous access should be utilized. Our coding dilemma is that the interventional radiology technician did not utilize a separate venous access. Additionally, CPT codes 36596 and 75902 describe removal of intraluminal obstructive material through device lumen, but according to the operative report the material was removed but not within the lumen of the catheter because the catheter was no longer present. Please advise on the reporting of this case and whether modifier 52 would be appropriately appended. ...
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