2025 CPT code 36904
(Active) Effective Date: N/A Revision Date: N/A Vascular Surgery - Dialysis Circuit Procedures Surgery Feed
Percutaneous transluminal mechanical thrombectomy and/or thrombolysis in the dialysis circuit, including imaging, radiological supervision, and pharmacological injection.
Modifiers 26 (professional component), TC (technical component), 51 (multiple procedures), 59 (distinct procedural service), and 76 (repeat procedure) may be applicable depending on the circumstances.
Medical necessity is established when a clot in the dialysis circuit impairs the patient's ability to receive dialysis, threatening their health and potentially life. The procedure is necessary to restore access functionality.
The physician performs the procedure under fluoroscopic guidance, interprets the images, and ensures the complete removal of the clot.
In simple words: This procedure removes a blood clot from a dialysis access line (a surgically created connection between an artery and vein used for dialysis).It uses special tools and/or medicine to dissolve the clot. The doctor uses X-ray guidance and interprets the images.
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis within the dialysis circuit using any method.This includes all imaging (diagnostic angiography and fluoroscopy), radiological supervision and interpretation, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s).The procedure encompasses thrombus removal from both peripheral and central dialysis circuit segments.
Example 1: A patient with an arteriovenous fistula (AVF) experiences a clot in the peripheral dialysis segment. The physician performs a percutaneous transluminal mechanical thrombectomy using a catheter and aspiration device, guided by fluoroscopy.The procedure includes diagnostic angiography., A patient with an arteriovenous graft (AVG) presents with a complete occlusion of the access. The physician performs thrombolysis using a thrombolytic agent administered through a catheter, followed by mechanical thrombectomy to remove the remaining clot. Fluoroscopy is used throughout, and the physician interprets the images., A patient experiences a clot spanning both the peripheral and central dialysis segments of their AVF. The physician uses a combination of mechanical thrombectomy and thrombolytic infusion to clear the clot, obtaining images with fluoroscopy at each stage of the procedure.
Detailed procedural notes including type of access (AVF, AVG), location of thrombus, methods used for thrombectomy and/or thrombolysis, types of catheters and instruments used, amount of thrombolytic agent (if used), fluoroscopic images before, during, and after the procedure, and final assessment of patency.
** This code includes all necessary catheterizations and manipulations. Ultrasound guidance, if used, should be reported separately using 76937.
- Payment Status: Active
- Modifier TC rule: Modifier TC may be used for the technical component (e.g., facility fees).
- Specialties:Vascular Surgery, Interventional Radiology, Nephrology
- Place of Service:Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center