How To Use CPT Code 36568

CPT 36568 describes the insertion of a peripherally inserted central venous catheter (PICC) in patients younger than 5 years of age, without the use of 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 36568?

CPT 36568 is used to report the insertion of a peripherally inserted central venous catheter (PICC) in patients who are younger than 5 years of age. This procedure involves the placement of a catheter through a vein in the upper extremity, which is then passed into one of the major veins that carry blood to the heart or directly into the right atrium. It is important to note that this code should only be used when a subcutaneous port or pump is not being inserted.

2. Official Description

The official description of CPT code 36568 is: ‘Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. Next, the provider locates the basilic or cephalic vein in the upper extremity of the patient.
3. Using a guidewire, the provider inserts the tip of the catheter through the skin and into the vein.
4. The provider then guides the catheter over the guidewire into one of the target veins, such as the brachiocephalic or innominate vein, iliac vein, subclavian vein, or superior or inferior vena cava.
5. Ultrasound or fluoroscopy may be used to assist in positioning the tip of the catheter at the target site.
6. After placing the catheter, the provider withdraws the guidewire, controls bleeding, and irrigates the insertion site with antibiotics.

4. Qualifying circumstances

CPT 36568 is appropriate for patients who are younger than 5 years of age and require the insertion of a peripherally inserted central venous catheter (PICC) without the use of a subcutaneous port or pump. It is important to note that this code should not be used for the placement of centrally inserted non-tunneled central venous catheters or peripherally inserted non-tunneled central venous catheters with imaging guidance.

5. When to use CPT code 36568

CPT code 36568 should be used when a provider is inserting a peripherally inserted central venous catheter (PICC) in a patient who is younger than 5 years of age and a subcutaneous port or pump is not being inserted. It is important to ensure that the procedure is performed without imaging guidance, as there are separate codes for PICC placement with imaging guidance.

6. Documentation requirements

To support a claim for CPT 36568, the provider must document the following information:

• Patient’s age
• Procedure performed (insertion of peripherally inserted central venous catheter without subcutaneous port or pump)
• Specific veins targeted for catheter placement
• Use of ultrasound or fluoroscopy, if applicable
• Confirmation of catheter tip location, if applicable
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 36568, ensure that the procedure is performed on a patient who is younger than 5 years of age and does not involve the insertion of a subcutaneous port or pump. It is important to note that imaging guidance should not be used during the procedure. Additionally, be aware of the bundled service codes that include imaging guidance and radiological supervision and interpretation for PICC placement or complete replacement.

8. Historical information

CPT 36568 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 provider inserts a peripherally inserted central venous catheter (PICC) in a 3-year-old patient without the use of a subcutaneous port or pump.
2. A provider places a catheter through a vein in the upper extremity of a 2-year-old patient and passes it into the superior vena cava, without the use of a subcutaneous port or pump.
3. A provider inserts a peripherally inserted central venous catheter (PICC) in a 4-year-old patient, targeting the brachiocephalic vein, without the use of a subcutaneous port or pump.
4. A provider guides a catheter over a guidewire into the subclavian vein of a 1-year-old patient, without the use of a subcutaneous port or pump.