36561- Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older - average fee payment - $1250 - $1350
This transmittal replaces all previous critical care payment policy
language. It includes the American Medical Association Current Procedural Terminology definitions of critical care and critical care services. It incorporates general Medicare evaluation and management payment policies that impact payment for critical care services. It also adds a new procedure code for 2008 (36591) which replaces code 36540. Code 36591 identifies a bundled vascular access procedure when performed with a critical care service.
It incorporates many Medicare evaluation and management payment policies that impact critical care services. It includes the current language from the American Medical Association (AMA) Current Procedural Terminology (procedure ) for definitions of critical care and critical care services. A coding change from AMA procedure 2008 is added which is for a vascular access procedure under section J (code 36591), a bundled procedure and deletes procedure code 36540.
Critical Care Services and Other Procedures Provided on the Same Day by the Same Physician as Critical Care Codes 99291 – 99292
The following services when performed on the day a physician bills for critical care are included in the critical care service and should not be reported separately:
• The interpretation of cardiac output measurements (procedure 93561, 93562);
• Chest x-rays, professional component (procedure 71010, 71015, 71020);
• Blood draw for specimen (procedure 36415);
• Blood gases, and information data stored in computers (e.g., ECGs, blood pressures, hematologic data-procedure 99090);
• Gastric intubation (procedure 43752, 91105);
• Pulse oximetry (procedure 94760, 94761, 94762);
• Temporary transcutaneous pacing (procedure 92953);
• Ventilator management (procedure 94002 – 94004, 94660, 94662); and
• Vascular access procedures (procedure 36000, 36410, 36415, 36591, 36600);
procedure 4 code 36410 may be used to bill non routine venipunctures for recipients 3 years of age or older. Anesthesiology services and assistant surgeon services are not payable for this procedure. Complex venipunctures for recipients younger than 3 years of age are reimbursable with procedure - 4 codes 36400 and 36405. Code 36400 is for billing complex venipuncture using the femoral vein or jugular vein and code 36405 is for billing complex venipuncture using the scalp vein.
Assistant surgeon services are not payable for this procedure. Note: Reimbursement for routine venipuncture is included in the reimbursement for laboratory procedures and is not separately reimbursable
Simple Cutdown Placement
Providers billing for the simple cutdown placement of central venous catheters (for example, for central venous pressure, hyperalimentation, hemodialysis or chemotherapy) should use procedure - 4 codes 36555, 36557 or 36568 for recipients under 5 years of age and codes 36556, 36558 or 36569 for recipients ages 5 years or older.