CPT code 36561, 36556

procedure code and description

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);

Complex Venipunctures:

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

We would bill the unsuccessful PICC with a modifier 52 and the successful PICC with no modifier (CPT 36556). 

“Procedures for which anesthesia is not planned that are discontinued, partially reduced or cancelled after the patient is prepared and taken to the room where the procedure is to be performed will be paid at 50 percent of the full OPPS payment amount. Modifier -52 is used for these procedures.”

Only one unit of 36556 with no modifier would be reported. The PICC line was successfully inserted eventually; it just took multiple attempts to accomplish it. Therefore, the first attempt would not be viewed as a reduced or cancelled separate procedure but just as a failed first attempt at a single procedure that was later successfully completed. As stated in Coding Clinic for HCPCS 3rd Qtr 2007 page 10: “Sometimes several unsuccessful attempts are made during the same operative episode to perform a procedure and finally the last attempt is successful. In this instance, only one unit of a single code would be reported for the procedure successfully accomplished, regardless of the numerous attempts. The unsuccessful attempts are considered a part of the successful procedure.”

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.

Procedure: Ultrasound was used to reveal a patent right subclavian vein. Permanent images were recorded. The region was anesthetized and access to the right subclavian vein was gained under direct ultrasound guidance with a 19 gauge needle. A guidewire was advanced into the venous system. The subcutaneous tunnel was anesthetized with Lidocaine with epinephrine. Incisions were made at the venotomy and the chest wall exit site. A 24cm 14-FR Ashsplit catheter was advanced from the chest wall exit site to the venotomy site with the supplied tunneling device.

Serial fascial dilation was then performed over a previously placed guidewire with final placement of a 15-FR peel-away sheath into the subclavian vein. The dilator and wire were removed followed by placement of the Ashsplit catheter into the venous system. The catheter was positioned at the cavatorial junction under fluoroscopy. The peel-away sheath was removed. The venotomy was closed with a single 3.0 Vicryl suture followed by Dermabond tissue. Assuming the procedure is done at the facility and the ultrasound equipment is owned by the facility; report the physician services for the procedure.

a. 585.9; 36556, 77001-26, 76937-26

b. V56.0; 36569, 76937-26

c. V58.81; 36558, 77001-26

d. V58.81, 585.9; 36558; 77001-26 and 76937-26

“d” Both fluoroscopy and ultrasound were used during the procedure. Permanent recorded ultrasound images were obtained during the procedure. Per CPT code 76937, ultrasonic guidance may be reported separately when permanent image documentation is present. Use of ultrasound without permanently recorded documentation may not be separately reported. Correct assignment for the imaging services is also stated in the Central Venous Access Procedures guidelines. The catheter was placed directly into the subclavian vein (centrally placed) and tunneled to the chest wall site. 

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