How To Use CPT Code 36561

CPT 36561 refers to the insertion of a tunneled, centrally inserted central venous access device with a subcutaneous port for patients aged 5 years or older. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 36561 procedures.

1. What is CPT 36561?

CPT 36561 is a medical billing code used to describe the insertion of a tunneled, centrally inserted central venous access device with a subcutaneous port for patients aged 5 years or older. This procedure is performed to provide long-term access to the patient’s central venous system for the administration of medications, fluids, or blood products, as well as for blood sampling.

2. 36561 CPT code description

The official description of CPT code 36561 is: “Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older.”

3. Procedure

1. Administration of anesthesia to the patient.
2. An incision is made in the deltopectoral groove area, and the subclavian vein is isolated.
3. A subcutaneous tunnel or pathway is created between the vein entry and external access sites.
4. A catheter is inserted into the vein near the heart using fluoroscopic guidance.
5. A separate incision is made, and pockets are created for the subcutaneous port.
6. The port is inserted and sutured into the pocket.
7. The catheter is connected to the port, and the incisions are closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 36561 services are those aged 5 years or older who require long-term central venous access for the administration of medications, fluids, or blood products, or for blood sampling. This may include patients with chronic illnesses, cancer, or those undergoing long-term intravenous therapy.

5. When to use CPT code 36561

It is appropriate to bill the 36561 CPT code when a tunneled, centrally inserted central venous access device with a subcutaneous port is inserted in a patient aged 5 years or older. This code should be used when the procedure is performed for the purpose of providing long-term central venous access for the administration of medications, fluids, or blood products, or for blood sampling.

6. Documentation requirements

To support a claim for CPT 36561, the following information should be documented:

• Patient’s age and medical necessity for the procedure.
• Details of the anesthesia administered.
• Location of the incisions and subcutaneous tunnel.
• Fluoroscopic guidance used during the procedure.
• Insertion and suturing of the subcutaneous port.
• Connection of the catheter to the port.
• Post-procedure care and follow-up instructions.

7. Billing guidelines

When billing for CPT code 36561, it is important to follow the appropriate guidelines and rules. Ensure that the patient’s age and medical necessity for the procedure are documented, and that the procedure is performed as described in the CPT code description. Additionally, bill separately for the fluoroscope or other imaging techniques used during the procedure. Avoid coding a catheter placement using only brand names or without complete documentation of the procedure, as physicians may use many popular types of catheters in several different ways.

8. Historical information

CPT 36561 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 36561

Five similar codes to CPT 36561 and how they differentiate from CPT 36561 are:

1. CPT 36555: Insertion of a non-tunneled, centrally inserted central venous catheter for patients aged 5 years or older.
2. CPT 36556: Insertion of a non-tunneled, centrally inserted central venous catheter for patients younger than 5 years.
3. CPT 36558: Insertion of a tunneled, centrally inserted central venous catheter without a subcutaneous port for patients aged 5 years or older.
4. CPT 36560: Insertion of a tunneled, centrally inserted central venous catheter without a subcutaneous port for patients younger than 5 years.
5. CPT 36571: Insertion of a peripherally inserted central venous catheter with a subcutaneous port for patients aged 5 years or older.

10. Examples

Here are 10 detailed examples of CPT code 36561 procedures:

1. A 7-year-old child with leukemia requiring long-term chemotherapy administration via a tunneled central venous access device with a subcutaneous port.
2. A 12-year-old patient with cystic fibrosis requiring long-term intravenous antibiotic therapy through a tunneled central venous access device with a subcutaneous port.
3. An adult patient with end-stage renal disease requiring long-term parenteral nutrition via a tunneled central venous access device with a subcutaneous port.
4. A 15-year-old patient with a severe infection requiring long-term intravenous antibiotic therapy through a tunneled central venous access device with a subcutaneous port.
5. An adult patient with cancer requiring long-term chemotherapy administration via a tunneled central venous access device with a subcutaneous port.
6. A 9-year-old child with a chronic illness requiring frequent blood sampling through a tunneled central venous access device with a subcutaneous port.
7. An adult patient with a gastrointestinal disorder requiring long-term parenteral nutrition via a tunneled central venous access device with a subcutaneous port.
8. A 6-year-old child with a severe infection requiring long-term intravenous antibiotic therapy through a tunneled central venous access device with a subcutaneous port.
9. An adult patient with a chronic illness requiring frequent blood sampling through a tunneled central venous access device with a subcutaneous port.
10. A 10-year-old child with end-stage renal disease requiring long-term parenteral nutrition via a tunneled central venous access device with a subcutaneous port.