Patient has an infusion port, port-a-cath or a central venous access device that flushes sluggishly due to obstruction (clot). Instead of saline or heparin being used to irrigate or flush the access device, a thrombolytic agent (tPA) is utilized for irrigation or flushing. How would the instillation of the thrombolytic agent be reported if it were the only service provided, and if it were administered via an intravenous push (IVP), or followed by a lab draw? Which CPT code would be more appropriate to report, 96523, Irrigation of implanted venous access device for drug delivery systems; 36593, Declotting by thrombolytic agent of implanted vascular access device or catheter; or 96374, Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug?
If the documentation in the health record supports the presence of a clot, CPT code 36593 may be reported for the declotting of an implanted device or catheter when a thrombolytic agent is used. However, if chemotherapy services are performed, the flushing is inherent and is not separately reported. Please note that routine flushing of vascular access devices with saline or heparin would not be reported separately with certain services (i.e., injection or infusion procedures).
CPT code 96523 may be reported if the patient is seen only for the irrigation/flushing of the vascular access device. Additionally, HCPCS code J2997, Injection, alteplase recombinant, 1 mg, would be reported for the TPA administration.