How To Use CPT Code 36590

CPT 36590 refers to the removal of a tunneled central venous access device with a subcutaneous port or pump. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 36590.

1. What is CPT 36590?

CPT 36590 is a medical procedure code used to describe the removal of a tunneled central venous access device, along with a subcutaneous port or pump, which was previously placed through a central or peripheral insertion. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 36590 CPT code description

The official description of CPT code 36590 is: “Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion.”

3. Procedure

The 36590 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the subcutaneous pocket.
3. The subcutaneous pocket is opened, and the port or pump is dissected free.
4. The port is disconnected from the catheter.
5. A guidewire is inserted over the catheter, and the catheter is withdrawn with the help of the guidewire.
6. The guidewire is removed, and the incision site is closed.
7. The wound is covered with a bandage.

4. Qualifying circumstances

Patients eligible to receive CPT code 36590 services are those who have a tunneled central venous access device with a subcutaneous port or pump that needs to be removed. This may be due to infection, device malfunction, or completion of treatment requiring the device. The decision to remove the device is typically made by the treating physician based on the patient’s medical condition and needs.

5. When to use CPT code 36590

It is appropriate to bill the 36590 CPT code when the provider performs the removal of a tunneled central venous access device with a subcutaneous port or pump, as described in the procedure section. This code should not be used for the removal of non-tunneled central venous catheters or when the removal does not involve a subcutaneous port or pump.

6. Documentation requirements

To support a claim for CPT 36590, the following information should be documented in the patient’s medical record:

• Indication for the removal of the tunneled central venous access device with a subcutaneous port or pump.
• Details of the procedure, including the steps performed, any complications encountered, and the outcome of the procedure.
• Pre- and post-procedure care provided to the patient.
• Any relevant patient history, including previous procedures involving the device.
• Provider’s signature and date of service.

7. Billing guidelines

When billing for CPT code 36590, it is essential to follow the specific guidelines and rules set forth by the payer. Some general tips for billing this code include:

• Ensure that the documentation supports the medical necessity of the procedure.
• Verify that the procedure was performed by a qualified provider.
• Check for any payer-specific requirements or restrictions related to CPT 36590.
• Review the patient’s insurance coverage and benefits for this procedure.
• Submit the claim with the appropriate modifiers, if applicable.

8. Historical information

CPT 36590 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 36590

Five similar codes to CPT 36590 and how they differentiate from CPT 36590 are:

1. CPT 36589: This code is used for the removal of a tunneled venous catheter without a subcutaneous port or pump.
2. CPT 36591: This code describes the collection of blood specimen from a completely implantable venous access device.
3. CPT 36592: This code is used for the collection of blood specimen using established central or peripheral venous catheter.
4. CPT 36593: This code refers to the declotting by thrombolytic agent of implanted venous access device or catheter.
5. CPT 36595: This code is for the mechanical removal of peripherally inserted central venous catheter obstruction.

10. Examples

Here are 10 detailed examples of CPT code 36590 procedures:

1. A patient with a history of cancer treatment requires removal of their tunneled central venous access device with a subcutaneous port due to completion of chemotherapy.
2. A patient with a tunneled central venous access device and subcutaneous pump experiences a device malfunction, necessitating removal and replacement.
3. A patient develops a severe infection at the site of their tunneled central venous access device with a subcutaneous port, requiring removal and antibiotic treatment.
4. A patient with a tunneled central venous access device and subcutaneous pump no longer requires long-term intravenous therapy and has the device removed.
5. A patient’s tunneled central venous access device with a subcutaneous port becomes dislodged, necessitating removal and reinsertion.
6. A patient with a history of total parenteral nutrition requires removal of their tunneled central venous access device with a subcutaneous port due to improvement in their nutritional status.
7. A patient with a tunneled central venous access device and subcutaneous pump experiences pain and discomfort at the site, leading to the decision to remove the device.
8. A patient’s tunneled central venous access device with a subcutaneous port becomes occluded, requiring removal and replacement with a new device.
9. A patient with a tunneled central venous access device and subcutaneous pump requires removal of the device due to a change in their treatment plan.
10. A patient with a history of long-term intravenous antibiotic therapy has their tunneled central venous access device with a subcutaneous port removed after successful treatment of their infection.