How To Use CPT Code 36557

CPT 36557 describes the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in an individual younger than five years of age. 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 36557?

CPT 36557 can be used to describe the insertion of a tunneled centrally inserted central venous catheter in a patient who is under the age of five. This code is used when a healthcare provider places a catheter, without a subcutaneous port or pump, in one of the major veins that carries blood to the heart or directly into the right atrium. The purpose of this procedure is to administer medication, nutrients, or fluids directly into the bloodstream.

2. Official Description

The official description of CPT code 36557 is: ‘Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age.’

3. Procedure

1. The healthcare provider locates the target vein in the upper chest area, which may include the brachiocephalic or innominate, iliac, subclavian, or superior or inferior vena cava.
2. 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.
3. A tunnel is created in the soft tissue of the chest area, and the catheter is passed over the guidewire, placing the tip of the catheter in the target vein.
4. The end of the catheter that is outside of the body is covered with local soft tissue and skin, and secured with sutures.
5. Any bleeding is controlled, and the insertion site is irrigated with antibiotics.

4. Qualifying circumstances

CPT 36557 is performed on patients who are younger than five years of age and require the insertion of a tunneled centrally inserted central venous catheter without a subcutaneous port or pump. This procedure is typically performed when the patient needs long-term administration of medication, nutrients, or fluids directly into the bloodstream.

5. When to use CPT code 36557

CPT code 36557 should be used when a healthcare provider performs the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a patient who is younger than five years of age. This code should not be used for patients who are five years of age or older, as there are separate codes for those age groups.

6. Documentation requirements

To support a claim for CPT 36557, the healthcare provider must document the following information:

• Patient’s age and the need for the tunneled centrally inserted central venous catheter
• Specific details of the procedure, including the target vein and the technique used for insertion
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 36557, ensure that the procedure is performed on a patient who is younger than five years of age and does not involve a subcutaneous port or pump. It is important to follow the specific guidelines for reporting this code and to avoid reporting it with other codes that may overlap or duplicate the services provided.

8. Historical information

CPT 36557 was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider inserts a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a four-year-old patient to administer long-term medication.
2. A pediatric surgeon performs the insertion of a tunneled centrally inserted central venous catheter in a three-year-old patient who requires regular nutrient administration.
3. An anesthesiologist places a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a two-year-old patient who needs continuous fluid infusion.
4. A pediatric hematologist inserts a tunneled centrally inserted central venous catheter in a five-month-old patient for the administration of chemotherapy.
5. A pediatric nurse practitioner performs the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a one-year-old patient who requires frequent blood transfusions.
6. A pediatric cardiologist places a tunneled centrally inserted central venous catheter in a four-year-old patient for the administration of cardiac medications.
7. A pediatric oncologist performs the insertion of a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a three-year-old patient who needs regular intravenous antibiotics.
8. A pediatric surgeon inserts a tunneled centrally inserted central venous catheter in a six-month-old patient for the administration of total parenteral nutrition.
9. An interventional radiologist places a tunneled centrally inserted central venous catheter, without a subcutaneous port or pump, in a four-year-old patient who requires frequent blood sampling.