Complete Replacement of Central Venous Access Device Through Same Venous Access Site (36580- 36585)
August 8th, 2012 - Nancy Maguire, ACS, PCS, FCS, HCS-D, CRTThe procedures involving central venous access devices fall into five categories:
- Insertion (placement of catheter through a newly established venous access
- Repair (fixing device without replacement of either catheter or port/pump, other than pharmacologic or mechanical correction of intracatheter or pericatheter occlusion [see 36595 or 36596])
- Partial replacement of only the catheter component associated with a port/pump device, not entire device
- Complete replacement of entire device via same venous access site (complete exchange)
- Removal of entire device
TUNNELED CATHETER: For a tunneled catheter, the physician will make one small incision in the skin commonly in the lower neck. Using ultrasound guidance, the vein is punctured with a needle (usually the jugular vein at the base of the neck), and a small guide wire is advanced into the large central vein, called the superior vena cava, under x-ray guidance (fluoroscopy). A second small skin incision may be made below the first, and a tunnel under the skin is then created. Using x-ray guidance, the catheter is placed through the tunnel into the vein, and the tip of the catheter is placed into the largest vein, the superior vena cava. The cuff, which is typically made of Dacron®, is located under the skin in the tunneled path of the catheter. Finally, the physician will place stitches at end of the tunnel to help keep the catheter firmly in place. The stitches do not typically need to be removed until the catheter is taken out.
PORT-CATHETER: Implanting a subcutaneous port generally requires two incisions (except in the arm where a single incision may suffice). The port reservoir is placed under the skin. A small skin incision slightly longer than the diameter of the device itself is made, and a small pocket for the port is created under the skin. The rest of the procedure is similar to the tunneled central catheter placement. A small, elevated area remains on your body at the site of the reservoir at the conclusion of the procedure. The port, which passes from an access site in a vein of your arm, shoulder or neck, ends in a large central vein in the chest. The reservoir has a silicone covering that can be punctured with a special needle.
A portable infusion pump (PP) is a device intended to provide ambulatory continuous drug infusion therapy over an extended time period. It is also known as an external pump, ambulatory pump, or a mini-infuser; and can be worn on a belt around the Infusion Pumps: patient's waist or from a shoulder harness. Acceptable routes are subcutaneous (SC) and intravenous (IV). A catheter from
the pump is attached to a needle in the desired access route for drug delivery. Driving mechanisms include motor-driven gear syringes, or positive-displacement valves. An implantable pump (IP) is intended to provide long-term continuous or intermittent drug infusion. Possible routes of administration includeintravenous, intra-arterial, subcutaneous, intraperitoneal, intrathecal, epidural, and intraventricular. The IP is surgically placed in a subcutaneous pocket under the infraclavicular fossa or in the abdominal wall, and a catheter is threaded into the desired position. A drug is infused over an extended period of time, and the drug reservoir may be refilled as needed by an external needle injection through a self-sealing septum in the IP. Bacteriostatic water or physiological saline is often used to dilute therapeutic drugs. A heparinized saline solution may also be used during an interruption of drug therapy to maintain catheter patency.
The three major types of complications most commonly associated with central venous catheters are mechanical, thrombotic, and infectious. Mechanical complications such as pneumothorax, hematoma, and accidental arterial puncture occur at a rate of 5 to 19%. Thrombotic occlusion, either partial or complete, occurs in 2% to 38% of catheterizations.
Example of a complication would be diagnosis code 996.74 (Other complications due to other vascular device, implant, and graft). 996.1 – Mechanical complication.
Infectious complication, either partial or complete, occurs at a rate of 5 to 26%. Infection is considered the most serious complication as it is accompanied by a mortality rate of 12-25%. Diagnosis code: 999.31 Other and unspecified infection due to central venous catheter, or 999.32 Bloodstream infection due to central venous catheter.
Replacement of Device
CPT codes 36580-36585 represent complete replacement of a central venous access device. There are key words to identify to ensure accurate code assignment.
Although some types of central venous catheter may remain in place for months or even years, most catheters require replacement after certain time frame because of poor function.
Questions to ask when considering these codes:
- Does documentation support a replacement?
- Is it a complete replacement?
- Through same venous access site?
- Is it a non-tunneled centrally inserted venous catheter without subcutaneous port or pump? (36580)
- Is it a tunneled centrally inserted venous catheter without subcutaneous port or pump? (36581)
- Is it a tunneled centrally inserted central venous access device, with subcutaneous port? (36582)
- Is it a tunneled centrally inserted central venous access device, with subcutaneous pump? (36583)
- Is the catheter a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump? (36584)
- Is it a complete replacement of a peripherally inserted central venous access device (PICC) with subcutaneous port? (36585)
- Diagnosis code: V58.81 – Removal or replacement of vascular catheter
Documentation must support removal of a tunneled central venous catheter, without port or pump (36589), or removal of tunneled central venous access device, with port or pump, central or peripheral (36590).
Consider this scenario:
Removal of port:
The correct code for the removal of a catheter with a port or pump is CPT code 36590 (Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion). Most of the tunneled insertion codes have a ten day global period. So you will append modifier 78 for the removal, if the patient was returned to the OR during the ten day global period. If the return to the OR was outside the ten day global period, then you do not need modifier 78. CPT code 36590 has a ten day global period, thus if you are not in the global period of an associated procedure, you will start a new ten day global period again related to the removal procedure.
Global 10 day period:
36557
36558
36560-36566
36570, 36571
36576, 36578
36581-36583
36585
36589-36590.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Artificial Intelligence in Healthcare - A Medical Coder's PerspectiveDecember 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?
Specialization: Your Advantage as a Medical Coding ContractorDecember 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike AgainDecember 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for AppendicitisNovember 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
