Medical necessity to code 36581

May 18, 2017

Question:

"Patient with known SVC occlusion, attempt to balloon dilation via his permcath as the primary access. PermCath was accessed, wire placed into IVC. Left common femoral vein was accessed a sheath was placed and then a wire placed into IVC. Confirmation I was in the correct location was performed with imaging. Next, I snared the wire from above and pulled it through the groin. In this way, I wanted to maintain access as the patient's only access for dialysis at this point was his PermCath. PermCath was dissected free using lidocaine and blunt dissection. PermCath was removed and sheath was placed. Through this, a venogram was performed. This demonstrated that we were through the occlusion, and therefore a balloon was placed across SVC and prox innominate vein for angioplasty of the occlusions. After I had exhausted many different attempts, I eventually replaced the PermCath (36581)." This patient did not come for catheter exchange. Should we code only catheter placement with venoplasty (36010, 37248)?

Question ID: 9310
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