How To Use CPT Code 36560

CPT 36560 describes the insertion of a tunneled centrally inserted central venous access device with a subcutaneous port for patients younger than 5 years of age. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36560?

CPT 36560 is used to describe the procedure of inserting a tunneled centrally inserted central venous access device with a subcutaneous port for patients who are younger than 5 years of age. This code is specifically for the placement of a catheter beneath the skin to draw blood or administer medication/nutrients to the patient. The catheter’s tip must terminate in specific veins near the heart, such as the brachiocephalic (innominate) or iliac vein, subclavian, the superior or inferior vena cava, or the right atrium. Tunneling is a technique used to place a long catheter under the skin between the vein entry and external access sites.

2. Official Description

The official description of CPT code 36560 is: ‘Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age.’ It is important to note that for peripherally inserted central venous access device with a subcutaneous port for patients younger than 5 years of age, CPT code 36570 should be used instead.

3. Procedure

1. The procedure begins with the administration of anesthesia to the patient.
2. An incision is made in the groove of the deltopectoral area to access the subclavian vein.
3. A subcutaneous tunnel or pathway is created to guide the catheter insertion.
4. The catheter is inserted into the vein near the heart.
5. A separate incision is made to create pockets for the subcutaneous port, which is then inserted and sutured into place.
6. Fluoroscopic guidance is used throughout the procedure to ensure accurate placement.

4. Qualifying circumstances

CPT 36560 is applicable for patients who are younger than 5 years of age and require the insertion of a tunneled centrally inserted central venous access device with a subcutaneous port. The catheter must terminate in specific veins near the heart, and tunneling is performed to create a pathway under the skin. It is important to note that for peripherally inserted central venous access device with a subcutaneous port for patients younger than 5 years of age, CPT code 36570 should be used instead.

5. When to use CPT code 36560

CPT code 36560 should be used when performing the insertion of a tunneled centrally inserted central venous access device with a subcutaneous port for patients who are younger than 5 years of age. It is important to ensure that the procedure meets the specific criteria outlined in the official description.

6. Documentation requirements

To support a claim for CPT code 36560, the following documentation is required:

• Confirmation of the patient’s age, indicating that they are younger than 5 years old
• Details of the specific veins near the heart where the catheter terminates
• Description of the tunneling technique used
• Date and time of the procedure
• Fluoroscopic guidance utilization
• Any additional relevant information or complications encountered during the procedure

7. Billing guidelines

When billing for CPT code 36560, it is important to ensure that the procedure meets the specific criteria outlined in the official description. Additionally, it is crucial to bill separately for any fluoroscopic guidance or other imaging techniques used during the procedure. It is also recommended to avoid using brand names or incomplete documentation when coding the catheter placement, as there are various types of catheters that may be used in different ways. It is important to review the specific guidelines and requirements of the payer when submitting the claim.

8. Historical information

CPT code 36560 was added to the Current Procedural Terminology system on January 1, 2004. On January 1, 2007, the code description was changed to specify that it is for patients younger than 5 years of age.

9. Examples

1. A 3-year-old patient requiring the insertion of a tunneled centrally inserted central venous access device with a subcutaneous port for long-term medication administration.
2. A 2-year-old patient in need of a tunneled centrally inserted central venous access device with a subcutaneous port for frequent blood draws.
3. A 4-year-old patient with a chronic illness requiring the insertion of a tunneled centrally inserted central venous access device with a subcutaneous port for regular nutrient infusions.
4. A 1-year-old patient undergoing chemotherapy who needs a tunneled centrally inserted central venous access device with a subcutaneous port for medication administration.
5. A 5-year-old patient who does not meet the age criteria for CPT 36560 but requires the insertion of a peripherally inserted central venous access device with a subcutaneous port.