CPT® Code 36905

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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

The procedure described by CPT® Code 36905 involves the use of percutaneous transluminal mechanical thrombectomy and/or infusion of thrombolytic agents to address 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. Thrombosis, or the formation of blood clots, is a common complication in these dialysis circuits, particularly with AV grafts, which have a higher incidence of clotting issues compared to AV fistulas. Clinically, symptoms of thrombosis can manifest as an absence of thrill or pulse at the site of the fistula or graft, swelling or distention of the vessel, and a lack of blood flash upon needle insertion. To accurately assess the extent of the thrombus, imaging techniques such as ultrasound or duplex Doppler studies may be employed. The procedure encompasses several critical steps, including the placement of needles and guidewires, the administration of thrombolytic agents, and the mechanical evacuation of clots if necessary. Additionally, if stenosis is detected in the dialysis circuit, balloon angioplasty may be performed to restore proper blood flow. This comprehensive approach ensures that both the thrombus and any associated stenosis are effectively managed, thereby optimizing the functionality of the dialysis circuit and improving patient outcomes.