2. Tunneled Catheter Removal & Exchange ASDIN Coding University 1

3. Tunneled Catheter Removal Tunneled catheter removal is performed under two circumstances: – Simple removal - the catheter is no longer needed; it is being removed, not to be immediately replaced – Catheter exchange - the catheter need is continuing, but it must be exchanged with a new catheter 2

4. Tunneled Catheter Removal The code for tunneled catheter removal is 36589 The descriptor for this code is – removal of tunneled central venous catheter, without subcutaneous port or pump 3

5. Tunneled Catheter Exchange Tunneled catheter exchange or replacement must be considered under two headings: – Exchange – same site – Replacement – new catheter at different site These are coded differently The key issue is the site of catheter placement which is defined as the venous entry site 4

6. Tunneled Catheter Exchange The new catheter is placed at the same venous entry site as the catheter removal Even when a new exit site and tunnel are created, if the venous entry site is the same, it is coded as an exchange 5

7. Primary Code for Catheter Exchange The code for catheter exchange is 36581 The descriptor for this code is - replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump through the same venous access 6

8. Additional Primary Code The code for fluoroscopic guidance is +77001 The descriptor for this code is - fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiologic documentation of final catheter position) This code includes any angiographic study that might be performed in conjunction with the catheter removal or replacement 7

9. Secondary Codes Used when unusual circumstances are encountered 35476 – Venous angioplasty 75978 – RS&I for 35476 36595 - fibrin sheath removal (for details on these codes and their recommended use, see unit on Insertion of Tunneled Catheter & unit on Venous Stenosis Associated with Tunneled Dialysis Catheter Placement and Exchange ) 8

10. Non-tunneled Catheter Exchanged With a Tunneled Catheter There are times when a non-tunneled catheter is exchanged with a tunneled catheter at the same site It is recommended that this be coded as a catheter exchange, the code for this is 36581 9

11. Replaced Using a New Access Site If the new catheter is placed at a new venous access site, different from the site where the old one has been removed, the case should not be classified as an exchange In this instance, the procedure should be classified as a replacement and two codes should be used 36589 should be used for the catheter removal 36558 should be used for the new catheter placement 10

12. Important Note This document is for informational purposes only and should serve as a guideline for appropriate coding. The ultimate responsibility for correct coding /documentation remains with the provider of service. ASDIN makes no representation, warranty, or guarantee that this compilation of information is error-free, nor that the use of this guide will prevent differences of opinion or disputes with CMS or any other carrier. ASDIN will bear no responsibility or liability for the results or consequences that may grow out of the use of this guidance.