How To Use CPT Code 36456

CPT 36456 describes the partial exchange transfusion procedure, which involves the injection of blood, plasma, or crystalloid solution by a qualified healthcare professional to restore or maintain blood volume in a newborn. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36456?

CPT 36456 is used to describe a partial exchange transfusion procedure performed by a physician or other qualified healthcare professional. This procedure involves injecting blood, plasma, or crystalloid solution into a newborn to restore or maintain their blood volume. It is important to note that CPT 36456 should not be reported in conjunction with codes 36430, 36440, or 36450, and modifier 63 should not be used with this code.

2. Official Description

The official description of CPT code 36456 is: ‘Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn.’

3. Procedure

1. The healthcare professional preps and anesthetizes the newborn infant.
2. An umbilical vein catheter is inserted by the provider.
3. The provider introduces donor blood, plasma, or a crystalloid solution (such as normal saline or lactated Ringer solution) to restore or maintain the infant’s blood volume.
4. The procedure is performed in multiple cycles at different time intervals.
5. After the procedure, the provider removes the catheter and stops any bleeding.

4. Qualifying circumstances

CPT 36456 is performed on newborn infants whose blood volume needs to be restored or maintained. The procedure is necessary when the infant’s blood volume is depleted due to surgical procedures or other causes. It requires the skill of a physician or other qualified healthcare professional.

5. When to use CPT code 36456

CPT code 36456 should be used when a physician or other qualified healthcare professional performs a partial exchange transfusion procedure on a newborn to restore or maintain their blood volume. It should not be reported in conjunction with codes 36430, 36440, or 36450.

6. Documentation requirements

To support a claim for CPT 36456, the healthcare professional must document the following information:

• Newborn’s diagnosis and the need for the partial exchange transfusion procedure
• Type of solution used (blood, plasma, or crystalloid)
• Date and time of the procedure
• Details of the procedure, including the amount of solution injected and any cycles performed
• Removal of the catheter and any post-procedure instructions
• Signature of the physician or qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 36456, ensure that the procedure is performed by a physician or other qualified healthcare professional. It should not be reported in conjunction with codes 36430, 36440, or 36450. Modifier 63 should not be used with this code. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 36456 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A physician performing a partial exchange transfusion procedure on a newborn to restore their blood volume after a surgical procedure.
2. A qualified healthcare professional administering a crystalloid solution to a newborn to maintain their blood volume due to other causes.
3. A physician performing multiple cycles of partial exchange transfusion on a newborn at different time intervals to restore their blood volume.
4. A qualified healthcare professional injecting donor blood into a newborn to maintain their blood volume during a critical medical condition.
5. A physician performing a partial exchange transfusion procedure on a newborn to restore their blood volume after a traumatic injury.
6. A qualified healthcare professional administering plasma to a newborn to maintain their blood volume during a severe illness.
7. A physician performing a partial exchange transfusion procedure on a newborn to restore their blood volume after a complicated delivery.
8. A qualified healthcare professional injecting a crystalloid solution into a newborn to maintain their blood volume during a surgical procedure.
9. A physician performing multiple cycles of partial exchange transfusion on a newborn to restore their blood volume after a prolonged illness.
10. A qualified healthcare professional administering donor blood to a newborn to maintain their blood volume during a congenital heart defect.