Summary & Overview
CPT 36593: Catheter-Directed Thrombolytic Administration for Occluded Venous Access
CPT code 36593 covers administration of a thrombolytic agent, such as tissue plasminogen activator (TPA), to dissolve a clot within an implanted venous access device or catheter. This targeted pharmacologic intervention restores device patency and can prevent device replacement, delays in treatment, and additional procedures. Nationally, the code matters because catheter-directed thrombolysis is commonly used across oncology, long-term infusion therapy, and critical care settings where implanted ports and central venous catheters are maintained.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when catheter-directed thrombolytic administration is billed, the typical sites of service where the procedure is performed, and an outline of commonly reported modifiers associated with this service. The publication also summarizes expected documentation elements, incidence of use in device occlusion management, and considerations for billing and claims processing.
This summary is intended for a national audience of clinicians, practice managers, and billing professionals. It highlights what CPT code 36593 represents, the clinical scenarios prompting its use, and the payer landscape relevant to reimbursement and administrative processing. Data not available in the input will be noted where applicable elsewhere in the full publication.
Billing Code Overview
CPT code 36593 describes administration of a thrombolytic drug, such as tissue plasminogen activator (TPA), to dissolve a clot in an implanted venous access device or catheter. The procedure involves delivering medication directly into an occluded central or peripheral venous catheter to restore patency of the device.
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Service type: Catheter-directed thrombolytic administration for occluded implanted venous access devices
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Typical site of service: Hospital outpatient department, inpatient hospital setting, ambulatory surgical center, or specialized infusion center where device occlusion and catheter-directed therapy are performed
Clinical & Coding Specifications
Clinical Context
A 62-year-old woman with an implanted totally implanted venous access port placed for long-term chemotherapy presents to the outpatient infusion center complaining of inability to flush or draw blood from the port prior to a scheduled infusion. The nurse documents resistance with attempted aspiration and a chest radiograph confirms the port catheter position without obvious fracture or migration. The provider assesses presumed fibrin sheath or intraluminal thrombotic occlusion and elects to instill a thrombolytic agent (such as tissue plasminogen activator) into the port lumen to restore patency. The procedure is performed at the outpatient infusion center or hospital outpatient department; the nurse or physician verifies informed consent, prepares aseptic technique, draws pre- and post-procedure flushes, administers the agent through the implanted device, observes the patient for immediate adverse reaction, and documents device patency restoration and any subsequent infusion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | Use when a distinct evaluation and management visit is performed in addition to 36593 on the same day. |