Can Declotting 36593 be coded separately from Chemo 96413?

Can Declotting 36593 be coded with Chemo 96413? I am referring to declotting with alteplase, not a flush.

There is no CCI edit. Dec 2009 CPT Assistant addresses, but I interpret it to be referring to a flush, not declotting.

Is this referring to the flush or declotting?

This code is not to be used for routine flushing of vascular access devices with saline or heparin. This type of flushing is considered inclusive in chemo-therapy services, and is not separately reported.

I'd love a clear reference.


  • Yes. Chemotherapy administration and the routine flushing of the device are part of the same procedure. Declotting the device is to address a separate situation that has nothing to do with the chemo administration. CPT guidelines do not address that this is part of the chemotherapy administration codes.

    Maybe this Coding Clinic for HCPCS will help.

    CPT Code 36593

    Coding Clinic for HCPCS, First Quarter 2014: Page 4 

    Coding advice contained in this issue is effective with procedures/services provided after April 30, 2014 unless otherwise noted. 


    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.

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