2025 CPT code 36905
(Active) Effective Date: N/A Cardiovascular System - Dialysis Circuit Procedures Surgery Feed
Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis of the dialysis circuit, including imaging, radiological supervision, and interpretation, diagnostic angiography, and intraprocedural pharmacological thrombolytic injections, with transluminal balloon angioplasty of the peripheral dialysis segment.
Modifiers may be applicable. Modifier 52 may be used for reduced services.
Medical necessity must be established by documenting the impaired dialysis access function due to thrombosis or stenosis. This may include reduced dialysis flow rates, difficulty with cannulation, or other clinical signs of access dysfunction.
The physician performs the procedure under fluoroscopic guidance, including accessing the dialysis circuit, injecting contrast for visualization, performing thrombectomy/thrombolysis, and carrying out balloon angioplasty. They also supervise and interpret the angiographic images.
In simple words: This procedure removes blood clots and opens narrowed blood vessels in the dialysis circuit. A catheter is inserted, and the clot is either removed with tools or dissolved with medication. A balloon is also used to widen any narrowed areas in the outer parts of the circuit. X-ray imaging is used to guide the procedure.
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. This procedure involves the removal of a blood clot from the dialysis circuit by mechanical means and/or injection of clot-dissolving medication. It also includes balloon angioplasty to widen narrowed areas in the peripheral segment of the circuit.
Example 1: A patient with a thrombosed arteriovenous fistula (AVF) undergoes mechanical thrombectomy and balloon angioplasty of a stenosis in the peripheral segment., A patient with a failing arteriovenous graft (AVG) receives thrombolytic therapy followed by balloon angioplasty of a stenosis near the anastomosis., A patient with an immature AVF has a clot removed and angioplasty performed in the peripheral segment under ultrasound guidance (76937 may be reported separately).
Documentation should include details of the thrombectomy/thrombolysis method, location and size of the clot, location and severity of stenosis, details of angioplasty (balloon size, inflation pressure, etc.), and confirmation of restored flow.Ultrasound guidance should be documented if used.
** Code 36905 includes all imaging, radiological supervision, and interpretation necessary for the procedure.If central vein intervention is also performed, use add-on code 36907 or 36908.
- Specialties:Interventional Radiology, Nephrology, Vascular Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office