Summary & Overview
CPT 36595: Removal of Fibrin or Obstruction from Central Venous Device Tip
CPT code 36595 denotes a targeted, minimally invasive intervention to remove obstructive material (for example, fibrin) from the tip of a central venous access device by introducing a wire or instrument through a separate venous access. Nationally, this code is important because it addresses catheter dysfunction that can interrupt chemotherapy, parenteral nutrition, hemodialysis and other therapies dependent on reliable central venous access.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a clinical and billing primer describing the procedure context, typical sites of service, and common scenarios prompting use of the code. The publication outlines common modifiers seen with procedural billing and identifies areas where documentation and coding specificity matter to support medical necessity. It also provides a policy and reimbursement overview summarizing payer coverage patterns where available and practical considerations for coding audits and quality reporting.
This resource is written for clinicians, revenue cycle staff, and policy analysts seeking a concise national-level briefing on clinical intent, billing practice, and payer considerations for CPT code 36595.
Billing Code Overview
CPT code 36595 describes a procedure in which the provider inserts a wire or other instrument through a separate venous access into or around a central venous access device tip to remove material, such as fibrin, that is obstructing flow through the device. This procedure is performed to restore or improve patency of an existing central venous access device.
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Service type: Device maintenance/intervention for central venous access (mechanical clearance of catheter tip obstruction)
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Typical site of service: Hospital inpatient or outpatient setting, interventional radiology suite, or specialized procedure room where sterile vascular access and imaging guidance are available
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Clinical & Coding Specifications
Clinical Context
A patient with a tunneled central venous access device (e.g., tunneled central venous catheter or port) presents with reduced or absent flow through the device during attempted infusion or aspiration. The patient may be receiving chemotherapy, long-term parenteral nutrition, or frequent IV antibiotics and reports difficulty flushing the catheter or experiencing brisk resistance during syringe attempts. Initial bedside evaluation includes assessment of external catheter integrity, attempts at simple flushing with saline and heparin, and review of recent interventions. When conservative measures fail to restore patency, the interventional radiology or vascular access team performs a catheter declot procedure.
The procedure involves inserting a guidewire or other instrument through a separate venous access site into or around the central catheter tip to mechanically disrupt and remove obstructing material such as fibrin sheaths or thrombus. Imaging guidance (fluoroscopy or ultrasound) is commonly used to confirm wire position and effectiveness. Typical workflow: preprocedure informed consent and device assessment; sterile preparation and local anesthesia; percutaneous venous access (often contralateral or ipsilateral peripheral vein); advancement of wire/catheter to device tip; mechanical disruption or thrombectomy maneuvers; aspiration of debris and evaluation of flow restoration; postprocedure hemostasis and documentation of catheter function. Typical sites of service include the interventional radiology suite, procedure room, or inpatient bedside when indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |