How To Use CPT Code 36584

CPT 36584 describes the complete replacement of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump, through the same venous access site. 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 36584?

CPT 36584 can be used to describe the complete replacement of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump, through the same venous access site. This code is used when the provider needs to replace the PICC due to infection, phlebitis, or another malfunction. The procedure includes all imaging guidance, documentation, and radiologic supervision and interpretation (RS&I).

2. Official Description

The official description of CPT code 36584 is: ‘Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the insertion site.
2. The provider carefully removes the existing PICC line.
3. Using the same opening, the provider inserts the tip of the catheter and a guidewire, guiding the catheter over the guidewire into the desired location (e.g., superior vena cava, inferior vena cava, or proximal right atrium).
4. The provider withdraws the guidewire and may use imaging guidance during the procedure.
5. After placing the catheter, the provider controls bleeding and irrigates the insertion site with antibiotics.
6. All imaging and RS&I required to perform the replacement are included in this procedure code.

4. Qualifying circumstances

CPT 36584 is used when a complete replacement of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump is necessary. This procedure is typically performed in cases of infection, phlebitis, or another malfunction. The replacement must be done through the same venous access site. It is important to note that this code should not be reported in conjunction with CPT codes 76937 or 77001.

5. When to use CPT code 36584

CPT code 36584 should be used when a complete replacement of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump is performed through the same venous access site. This code should not be used when the replacement does not involve imaging guidance. If the replacement is performed without imaging guidance, CPT code 37799 should be used instead.

6. Documentation requirements

To support a claim for CPT code 36584, the provider must document the following information:

• Reason for the complete replacement of the PICC (e.g., infection, phlebitis, malfunction)
• Details of the imaging guidance used, if applicable
• Date of the procedure
• Start and end time of the procedure
• Specific location where the catheter was placed (e.g., superior vena cava, inferior vena cava, proximal right atrium)
• Any additional procedures performed during the replacement
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 36584, ensure that the complete replacement of the PICC without a subcutaneous port or pump is performed through the same venous access site. Do not report CPT code 36584 in conjunction with CPT codes 76937 or 77001. It is important to note that there are specific coding guidelines for central venous access device procedures, so it is recommended to review the code range 36555-36598 for additional information and directions on coding.

8. Historical information

CPT code 36584 was added to the Current Procedural Terminology system on January 1, 2004. The code was later revised on January 1, 2019 to specify the complete replacement of a peripherally inserted central venous catheter (PICC) without a subcutaneous port or pump through the same venous access site.

9. Examples

1. A patient requires a complete replacement of a peripherally inserted central venous catheter (PICC) due to infection. The provider performs the replacement through the same venous access site, using imaging guidance to ensure proper placement of the new catheter.
2. After experiencing phlebitis, a patient needs a complete replacement of their peripherally inserted central venous catheter (PICC). The provider performs the replacement without imaging guidance, but ensures that the new catheter is properly placed through the same venous access site.
3. A malfunctioning peripherally inserted central venous catheter (PICC) needs to be replaced. The provider uses imaging guidance to guide the new catheter into the desired location through the same venous access site.
4. Due to an infection, a patient’s peripherally inserted central venous catheter (PICC) requires a complete replacement. The provider performs the replacement without imaging guidance, ensuring that the new catheter is inserted through the same venous access site.
5. A patient’s peripherally inserted central venous catheter (PICC) needs to be replaced due to malfunction. The provider uses imaging guidance to guide the new catheter into the desired location through the same venous access site.