CPT® Code 36904

Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s);

The procedure described by CPT® Code 36904 involves a specialized intervention aimed at addressing blood clots within the dialysis circuit. This circuit may include components such as a central venous catheter (CVC), an arteriovenous (AV) fistula, or a synthetic AV graft. The primary goal of this procedure is to dissolve or mechanically remove thrombi that can obstruct blood flow, which is critical for effective dialysis treatment. Thrombosis is particularly prevalent in AV grafts, but can also occur in AV fistulas, leading to symptoms such as the absence of a palpable thrill or pulse at the site, swelling of the vessel, or lack of blood return upon needle insertion. To accurately assess the extent of the thrombus, imaging techniques like ultrasound or duplex Doppler studies may be employed. The procedure itself can involve either mechanical thrombectomy or the infusion of thrombolytic agents, such as heparin or tissue plasminogen activator (TPA), to facilitate clot dissolution. The intervention is performed under fluoroscopic guidance, ensuring precise catheter placement and monitoring throughout the process. This comprehensive approach includes diagnostic angiography to visualize the vascular anatomy and any residual clots or stenosis, which may necessitate further interventions such as balloon angioplasty or stent placement to restore optimal blood flow within the dialysis circuit.