How To Use CPT Code 36558

CPT 36558 refers to the insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump in patients aged 5 years or older. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 36558 procedures.

1. What is CPT 36558?

CPT 36558 is a medical procedure code used to describe the insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump in patients aged 5 years or older. This procedure is performed to administer medication, nutrients, or fluids directly into the bloodstream through one of the major veins or directly into the right atrium of the heart.

2. 36558 CPT code description

The official description of CPT code 36558 is: “Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older.”

3. Procedure

The 36558 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider locates the target vein in the upper chest area, which may include the brachiocephalic, innominate, iliac, subclavian, superior or inferior vena cava, or the right atrium of the heart.
3. The provider inserts the tip of the catheter using a needle or cut-down approach through the skin and may use ultrasound or fluoroscopy to position a guidewire.
4. An incision is made in the skin of the chest area to create a tunnel in the soft tissue.
5. The catheter is passed over the guidewire, placing the tip of the catheter in the target vein.
6. The end of the catheter, which is outside of the body from the tunnel, is covered with local soft tissue and skin, and secured with sutures.
7. Bleeding is controlled, and the insertion site is irrigated with antibiotics.

4. Qualifying circumstances

Patients eligible to receive CPT code 36558 services are those aged 5 years or older who require the insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump. This procedure is typically performed for patients who need long-term administration of medication, nutrients, or fluids directly into the bloodstream, or for those who require frequent blood withdrawals for monitoring purposes.

5. When to use CPT code 36558

It is appropriate to bill the 36558 CPT code when the provider performs the insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump in a patient aged 5 years or older. The procedure should be medically necessary and supported by proper documentation.

6. Documentation requirements

To support a claim for CPT 36558, the following information should be documented:

• Patient’s age
• Medical necessity for the procedure
• Details of the procedure, including the target vein, method of insertion, and use of imaging guidance if applicable
• Post-procedure care, such as controlling bleeding and irrigating the insertion site with antibiotics
• Any complications or additional procedures performed during the catheter insertion

7. Billing guidelines

When billing for CPT code 36558, it is essential to follow the appropriate guidelines and rules. If the provider uses fluoroscopic guidance, report +77001 in addition to the primary procedure code. If ultrasound guidance is used, report +76937 along with the primary procedure code. Be cautious when coding catheter placements using only brand names or without complete documentation, as physicians may use various types of catheters in different ways. Familiarize yourself with the specific catheter types and their corresponding codes to ensure accurate billing.

8. Historical information

CPT 36558 was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates to the code since its addition.

9. Similar codes to CPT 36558

Five similar codes to CPT 36558 and how they differ are:

• CPT 36557: Insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump in a patient younger than 5 years old.
• CPT 36555: Insertion of a nontunneled centrally inserted central venous catheter in a patient less than 5 years old.
• CPT 36556: Insertion of a nontunneled centrally inserted central venous catheter in a patient 5 years of age or older.
• CPT 36568: Insertion of a peripherally inserted central venous catheter (PICC) without imaging guidance and without subcutaneous port or pump in patients younger than 5 years of age.
• CPT 36569: Insertion of a peripherally inserted central venous catheter (PICC) without imaging guidance and without subcutaneous port or pump in patients 5 years old or older.

10. Examples

Here are 10 detailed examples of CPT code 36558 procedures:

1. A 6-year-old patient with a chronic infection requiring long-term intravenous antibiotic therapy.
2. A 12-year-old patient with cancer who needs a tunneled central venous catheter for chemotherapy administration.
3. An 8-year-old patient with a gastrointestinal disorder requiring long-term parenteral nutrition.
4. A 15-year-old patient with a blood disorder requiring frequent blood withdrawals for monitoring purposes.
5. A 7-year-old patient with a chronic kidney disease who needs a tunneled central venous catheter for hemodialysis.
6. A 10-year-old patient with a severe burn injury requiring long-term intravenous fluid administration.
7. A 9-year-old patient with a congenital heart defect requiring long-term intravenous medication administration.
8. An 11-year-old patient with a chronic lung disease requiring long-term intravenous medication administration.
9. A 13-year-old patient with a bone marrow transplant requiring a tunneled central venous catheter for blood product administration and monitoring.
10. A 5-year-old patient with a rare metabolic disorder requiring long-term intravenous enzyme replacement therapy.