How To Use CPT Code 36823

CPT 36823 describes the insertion of arterial and venous cannula(s) for isolated extracorporeal circulation, including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with the removal of cannula(s) and repair of arteriotomy and venotomy sites. 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 36823?

CPT 36823 can be used to describe the procedure of inserting arterial and venous cannula(s) for isolated extracorporeal circulation, along with regional chemotherapy perfusion to an extremity. This code also includes the removal of the cannula(s) and repair of arteriotomy and venotomy sites. The aim of this procedure is to provide targeted chemotherapy to kill cancer cells in the extremity.

2. Official Description

The official description of CPT code 36823 is: ‘Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation, including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) and repair of arteriotomy and venotomy sites. This code includes chemotherapy perfusion supported by a membrane oxygenator/perfusion pump. Do not report 96409 – 96425 in conjunction with 36823.’

3. Procedure

1. The provider begins by preparing and anesthetizing the patient.
2. Next, the provider identifies the artery and vein of the extremity to be used for isolated extracorporeal circulation.
3. The provider then inserts the arterial and venous cannula(s) into the selected artery and vein.
4. The cannula in the vein acts as an exit point for the oxygen-depleted blood from the extremity, which is diverted into an external device acting as an artificial lung or oxygenator.
5. The cannula in the artery acts as an entry point for the oxygenated blood returning from the external device, providing isolated extracorporeal circulation.
6. The provider administers a high dose of chemotherapy agent through the external device, targeting and killing the cancer cells in the extremity.
7. Once the chemotherapy procedure is complete, the provider removes the cannula(s) and closes the puncture sites in the artery and vein.

4. Qualifying circumstances

CPT 36823 is performed on patients who require isolated extracorporeal circulation and regional chemotherapy perfusion to an extremity. This procedure is typically used to treat cancer in the extremity. The provider must insert arterial and venous cannula(s) and perform the necessary repair of arteriotomy and venotomy sites. The use of a membrane oxygenator/perfusion pump to support chemotherapy perfusion is also included in this code.

5. When to use CPT code 36823

CPT code 36823 should be used when the provider performs the insertion of arterial and venous cannula(s) for isolated extracorporeal circulation, along with regional chemotherapy perfusion to an extremity. This code should be reported when the procedure includes the removal of the cannula(s) and repair of arteriotomy and venotomy sites. It is important to note that other codes, such as 96409 – 96425, should not be reported in conjunction with CPT 36823.

6. Documentation requirements

To support a claim for CPT 36823, the provider must document the following information:

• Patient’s diagnosis and the need for isolated extracorporeal circulation and regional chemotherapy perfusion
• Specific details of the procedure, including the insertion of arterial and venous cannula(s), use of a membrane oxygenator/perfusion pump, and repair of arteriotomy and venotomy sites
• Date of the procedure
• Start and end time of the procedure
• Details of the chemotherapy perfusion, including the type and dosage of the chemotherapy agent
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 36823, ensure that the procedure includes the insertion of arterial and venous cannula(s) for isolated extracorporeal circulation, regional chemotherapy perfusion to an extremity, removal of the cannula(s), and repair of arteriotomy and venotomy sites. It is important to note that other codes, such as 96409 – 96425, should not be reported in conjunction with CPT 36823. Follow the appropriate coding guidelines and modifiers when reporting this code.

8. Historical information

CPT 36823 was added to the Current Procedural Terminology system on January 1, 1999. There have been historical changes to the code, including updates to the description and the addition of the code to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider inserts arterial and venous cannula(s) for isolated extracorporeal circulation, performs regional chemotherapy perfusion to an extremity, and removes the cannula(s) and repairs arteriotomy and venotomy sites for a patient with localized sarcoma in the arm.
2. A provider performs the insertion of arterial and venous cannula(s) for isolated extracorporeal circulation, administers regional chemotherapy perfusion to an extremity, and repairs arteriotomy and venotomy sites for a patient with melanoma in the leg.