How To Use CPT Code 49436

CPT 49436 describes the procedure of creating an exit site for an already installed subcutaneous segment of an intraperitoneal cannula or catheter. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49436?

CPT 49436 can be used to describe the delayed creation of an exit site for an embedded subcutaneous segment of an intraperitoneal cannula or catheter. This code is used when the provider makes an incision to create a separate exit site for the already installed cannula or catheter.

2. Official Description

The official description of CPT code 49436 is: ‘Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the abdomen over the previous scar above the cannula or catheter placement site.
3. The provider removes scar tissue and locates the existing cannula.
4. A separate incision is made for the exit site.
5. The cannula is passed through a subcutaneous tunnel and secured in place.
6. The end of the tunnel is attached to an appropriate device for drug delivery or other purposes.
7. The original incision used to access the tube is repaired.

4. Qualifying circumstances

Patients eligible for CPT 49436 are those who already have an embedded subcutaneous segment of an intraperitoneal cannula or catheter and require the creation of a separate exit site. The procedure is performed by a qualified healthcare provider. The terms ‘cannula’ and ‘catheter’ are defined as a tube through which instruments can be inserted or a flexible tube inserted into a vessel or tubular structure, respectively. The procedure is performed within the peritoneal cavity of the abdomen and below the surface of the skin.

5. When to use CPT code 49436

CPT code 49436 should be used when a provider performs the delayed creation of an exit site for an embedded subcutaneous segment of an intraperitoneal cannula or catheter. It should not be used for initial catheter or cannula placement or when adding an extension to reach a remote chest exit site during the same session.

6. Documentation requirements

To support a claim for CPT 49436, the provider must document the following information:

• Patient’s medical history and the need for the delayed creation of an exit site
• Details of the procedure, including the incisions made and the subcutaneous tunnel created
• Any devices attached to the exit site
• Repair of the original incision
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 49436, ensure that the procedure meets the criteria described in the official description. It should be reported as a separate procedure and not in conjunction with other codes. If an extension is added during the same session, a different code should be used. Consider the location of the exit site when coding this procedure.

8. Historical information

CPT 49436 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A provider creates an exit site for an embedded subcutaneous segment of an intraperitoneal catheter in a patient who requires ongoing drug delivery.
2. A surgeon performs the delayed creation of an exit site for an intraperitoneal cannula in a patient who needs regular fluid instillation.
3. A healthcare provider makes an incision to create an exit site for an embedded subcutaneous segment of an intraperitoneal catheter in a patient who requires frequent blood withdrawal.
4. A provider performs the procedure to create an exit site for an intraperitoneal cannula in a patient who needs continuous monitoring of intraperitoneal pressure.
5. A surgeon makes an incision to create an exit site for an embedded subcutaneous segment of an intraperitoneal catheter in a patient who requires regular instillation of contrast dye for imaging purposes.
6. A healthcare provider performs the delayed creation of an exit site for an intraperitoneal cannula in a patient who needs regular drainage of ascitic fluid.
7. A provider creates an exit site for an embedded subcutaneous segment of an intraperitoneal catheter in a patient who requires ongoing chemotherapy.
8. A surgeon performs the procedure to create an exit site for an intraperitoneal cannula in a patient who needs regular dialysis.
9. A healthcare provider makes an incision to create an exit site for an embedded subcutaneous segment of an intraperitoneal catheter in a patient who requires continuous intraperitoneal nutrition.
10. A provider performs the delayed creation of an exit site for an intraperitoneal cannula in a patient who needs regular drainage of infected fluid.