Surgical implantation of an intravascular catheter system is usually accomplished under local anesthesia. The catheter is inserted at the appropriate location and subcutaneously routed to the portal implantation site. The portal is implanted, connected with the catheter, and checked for patency and flow. Finally, the entire system is flushed with heparin to prevent thrombosis.

Implantation of a subcutaneous intravascular catheter is an eligible surgical procedure and should be processed under codes 36557, 36558, 36560, 36561, 36565, 36566, 36570, 36571. Code 36589 represents the removal of the subcutaneous intravascular catheter.

NOTE:

The allowance for the removal of a central venous catheter (e.g., Hickman, Broviac) is included in the allowance for the placement of the catheter. Also see Medical Policy Bulletin S-52 for more information.

Subcutaneous intravascular catheter maintenance (e.g., flushing of a vascular access port) is eligible for payment as a distinct and separate service. Code 96523 represents catheter maintenance.

Port puncture (i.e., access) is considered an integral part of a doctor's medical care. It is not eligible as a distinct and separate service when performed with medical services. If port puncture is reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care. Payment for the medical care performed on the same date of service includes the allowance for the port puncture. A participating, preferred, or network provider cannot bill the member separately for the port puncture in this case.

If the port puncture is performed independently, process it under procedure code 37799.

Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the port puncture. When the 25 modifier is reported, the patient’s records must clearly document that separately identifiable medical care has been rendered.

Description

Subcutaneous intravascular catheter systems (e.g., Infusaport, Port-A-Cath, etc.) are indicated in some patients requiring repeated or continuous access to veins, arteries, or body cavities for the administration of drugs, parenteral nutritional solutions, or for the withdrawal of blood samples. Some patients undergoing repeated venipuncture eventually suffer thrombosis or other vein damage, making repeated venous access painful or dangerous. Conventional indwelling central venous catheters such as the Hickman or Broviac can be uncomfortable, require patient maintenance, and are at a higher risk for infection. In addition, the patient does not have the freedom of movement with a protruding Hickman or Broviac catheter that is afforded by an implanted system.