CPT® Code 36823

1. Indications

The procedure described by CPT® Code 36823 is indicated for specific clinical scenarios where isolated regional chemotherapy perfusion is necessary. The following conditions may warrant this procedure:

• Regional Chemotherapy Treatment This procedure is performed to deliver chemotherapy agents directly to an extremity, allowing for higher concentrations of the drug at the tumor site while reducing systemic exposure and potential side effects.
• Extremity Tumors Patients with localized tumors in the arms or legs may benefit from this targeted approach, particularly when traditional systemic chemotherapy is less effective.
• Hyperthermia Therapy The procedure may also be indicated when hyperthermia is used in conjunction with chemotherapy to enhance the treatment's effectiveness by increasing drug uptake and cytotoxicity in cancer cells.

2. Procedure

The procedure involves several critical steps to ensure successful cannulation and perfusion:

• Step 1: Administration of Anticoagulant A systemic anticoagulant is administered to prevent clot formation during the procedure, ensuring smooth blood flow through the cannulas.
• Step 2: Identification of Vessels The major inflow (arterial) and outflow (venous) vessels are identified, which are typically located in the targeted extremity where the chemotherapy will be administered.
• Step 3: Incision and Exposure An incision is made in the skin over the identified vessels, allowing for direct access. The vessels are then carefully exposed to facilitate the next steps.
• Step 4: Cannula Insertion The vessels are incised, and the arterial and venous cannulas are inserted. This may also be accomplished using a percutaneous technique, which involves a needle puncture to access the vessels without a large incision.
• Step 5: Application of Tourniquet A tourniquet is applied to temporarily control outflow from collateral vessels, ensuring that the blood flow is directed appropriately for the procedure.
• Step 6: Isolation Confirmation The isolation of the extremity from systemic circulation is confirmed using techniques such as the injection of contrast material or radiolabeled red blood cells or serum, ensuring that the chemotherapy agent will be effectively delivered to the targeted area.
• Step 7: Chemotherapy Perfusion The chemotherapy agent is then perfused into the isolated extremity, allowing for localized treatment of the tumor.
• Step 8: Hyperthermia (if applicable) If hyperthermia is part of the treatment plan, temperature probes are placed, and the extremity is heated to the desired temperature to enhance the effectiveness of the chemotherapy.
• Step 9: Cannula Removal and Site Repair Upon completion of the procedure, the cannulas are removed, and the arteriotomy and venotomy sites are repaired to promote healing and minimize complications.

3. Post-Procedure

After the procedure, careful monitoring of the patient is essential to assess for any complications or adverse effects. The sites of arteriotomy and venotomy should be observed for signs of bleeding or infection. Patients may require follow-up care to evaluate the effectiveness of the chemotherapy and manage any side effects. Additionally, instructions regarding activity restrictions and wound care should be provided to ensure proper recovery.