How To Use CPT Code 96523

CPT 96523 refers to the irrigation of implanted venous access devices for drug delivery systems. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96523.

1. What is CPT 96523?

CPT 96523 is a medical procedure code that describes the irrigation, or flushing, of an implanted venous access device used for administering drugs to patients. These devices are small, flexible tubes implanted under the skin, allowing access to a vein without multiple needle pricks. They are commonly used for administering medications such as chemotherapy directly into large veins and can remain implanted for extended periods.

2. 96523 CPT code description

The official description of CPT code 96523 is: “Irrigation of implanted venous access device for drug delivery systems.”

3. Procedure

1. The provider prepares the flushing solution, typically a mixture of normal saline and heparin.
2. The solution is drawn into a syringe.
3. The provider cleans the skin around the venous access device or port.
4. The syringe is connected to the port, and the solution is injected into the device to flush it.
5. The provider ensures that the device is functioning correctly and that there are no complications.

4. Qualifying circumstances

Patients with implanted venous access devices for drug delivery systems, such as those receiving chemotherapy or other long-term intravenous treatments, are eligible for CPT 96523 services. The procedure is performed to maintain the functionality of the device and prevent complications such as blockages or infections.

5. When to use CPT code 96523

CPT code 96523 should be used when a provider performs the irrigation of an implanted venous access device for drug delivery systems, and no other services, including evaluation and management or chemotherapy, are provided on the same day. Medicare and other payers may bundle the payment for 96523 with other services if they are provided on the same day.

6. Documentation requirements

To support a claim for CPT 96523, the following information should be documented:

• Patient’s medical history and the reason for the implanted venous access device.
• Date and time of the irrigation procedure.
• Details of the flushing solution used, including the type and amount.
• Confirmation that the device was functioning correctly after the procedure.
• Any complications or issues encountered during the procedure.

7. Billing guidelines

When billing for CPT 96523, it is essential to follow payer-specific guidelines and rules. Generally, 96523 should only be billed when no other services are provided on the same day. If other services are provided, the payment for 96523 may be bundled with the payment for the other services. Additionally, do not report 96523 in conjunction with blood specimen collection (use 36591 instead).

8. Historical information

CPT 96523 was added to the Current Procedural Terminology system on January 1, 2006. There have been no significant updates to the code since its addition.

9. Similar codes to CPT 96523

Five similar codes to CPT 96523 and how they differ are:

• CPT 36591: Collection of blood specimen from a completely implantable venous access device. This code is used for blood collection, not irrigation.
• CPT 96360: Intravenous infusion, hydration; initial 31 minutes to 1 hour. This code is for IV hydration, not device irrigation.
• CPT 96365: Intravenous infusion for therapy, prophylaxis, or diagnosis; initial, up to 1 hour. This code is for therapeutic IV infusions, not device irrigation.
• CPT 96374: Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug. This code is for IV push injections, not device irrigation.
• CPT 96413: Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug. This code is for chemotherapy administration, not device irrigation.

10. Examples

1. A patient with an implanted venous access device for chemotherapy treatment requires a routine port flush to maintain the device’s functionality.
2. A patient with a history of deep vein thrombosis has an implanted venous access device for long-term anticoagulant therapy and requires a port flush.
3. A patient with a chronic infection requiring long-term intravenous antibiotic therapy has an implanted venous access device that needs irrigation.
4. A patient receiving long-term parenteral nutrition through an implanted venous access device requires a port flush to prevent complications.
5. A patient with an implanted venous access device for pain management medication delivery needs a routine port flush.
6. A patient with a history of multiple sclerosis has an implanted venous access device for long-term immunomodulatory therapy and requires a port flush.
7. A patient with an implanted venous access device for long-term intravenous antifungal therapy needs a routine port flush.
8. A patient receiving long-term intravenous immunoglobulin therapy through an implanted venous access device requires a port flush to maintain the device’s functionality.
9. A patient with an implanted venous access device for long-term enzyme replacement therapy needs a routine port flush.
10. A patient with a history of congestive heart failure has an implanted venous access device for long-term inotropic therapy and requires a port flush.