How To Use CPT Code 36565

CPT 36565 describes the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites, without a subcutaneous port or pump. 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 36565?

CPT 36565 can be used to describe the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites, without a subcutaneous port or pump. This code is used when a physician inserts the device beneath the skin to draw blood or administer medication and nutrients to the patient. Tunneling refers to the technique of placing a long catheter under the skin between the vein entry and external access sites.

2. Official Description

The official description of CPT code 36565 is: ‘Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter)’

3. Procedure

1. The physician administers anesthesia to the patient.
2. Two separate incisions are made in the groove of the deltopectoral muscle.
3. The subclavian vein is isolated.
4. A double lumen catheter, such as a Tesio® type catheter, is inserted into the central vein.
5. The catheter is tunneled through the chest wall.
6. The catheter is tied up and the incision site is closed.

4. Qualifying circumstances

CPT 36565 is used when a tunneled centrally inserted central venous access device with two catheters is inserted via two separate venous access sites, without a subcutaneous port or pump. This procedure is typically performed when the patient requires long-term access for the administration of medication, fluids, or nutrients. It is important to note that the device’s tip must terminate in the brachiocephalic or iliac vein, subclavian, the superior or inferior vena cava, or the right atrium.

5. When to use CPT code 36565

CPT code 36565 should be used when a physician performs the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites, without a subcutaneous port or pump. It is important to ensure that the procedure meets the specific requirements outlined in the code description.

6. Documentation requirements

To support a claim for CPT 36565, the physician must document the following information:

• Details of the procedure, including the number of catheters inserted and the number of venous access sites used
• Specific type of catheter used, such as a Tesio® type catheter
• Date of the procedure
• Incision sites and closure method
• Any additional relevant details or complications encountered during the procedure

7. Billing guidelines

When billing for CPT 36565, ensure that the procedure meets the specific requirements outlined in the code description. It is important to bill separately for any fluoroscopic guidance or other imaging techniques used during the procedure. Additionally, it is crucial to avoid coding for catheter placement using only brand names or without complete documentation of the procedure. Proper coding can be guided by understanding the different types of catheters commonly used and their corresponding coding implications.

8. Historical information

CPT 36565 was added to the Current Procedural Terminology system on January 1, 2004. The code description was updated on January 1, 2010 to include the specific requirement of two catheters via two separate venous access sites.

9. Examples

1. A physician performing the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient requiring long-term administration of medication and nutrients.
2. A surgeon inserting a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient undergoing chemotherapy.
3. An interventional radiologist performing the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient in need of frequent blood transfusions.
4. A vascular surgeon inserting a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient with kidney failure requiring hemodialysis.
5. A cardiologist performing the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient in need of long-term intravenous medication administration.
6. An anesthesiologist inserting a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient undergoing major surgery.
7. A pediatric surgeon performing the insertion of a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a child with a chronic illness requiring frequent medical interventions.
8. An oncologist inserting a tunneled centrally inserted central venous access device with two catheters via two separate venous access sites for a patient undergoing radiation therapy.