CPT code 36558 is used for the procedure of inserting a tunneled central venous catheter, often for long-term medication or nutrition delivery.
CPT code 36558 is used to describe the procedure of inserting a tunneled central venous catheter. This procedure involves placing a catheter into a large vein, typically in the chest or neck, and tunneling it under the skin to reduce the risk of infection. The catheter is used for long-term intravenous access, which can be necessary for patients requiring extended medication administration, nutrition, or dialysis. The "tunneled" aspect refers to the catheter being placed under the skin before entering the vein, providing a more secure and less infection-prone access point compared to non-tunneled catheters.
For the CPT code 36558, which involves the insertion of a tunneled central venous catheter, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the procedure was not performed in its entirety.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician subsequent to the original procedure.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician subsequent to the original procedure.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
9. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with the specific circumstances of the procedure and the payer's guidelines. Proper documentation is essential to support the use of any modifier.
CPT code 36558, which involves the insertion of a tunneled central venous catheter, is reimbursed by Medicare, subject to specific conditions and guidelines. The reimbursement for this procedure is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. The MPFS is updated annually and considers various factors, including the relative value units (RVUs) assigned to the procedure, geographic location, and other adjustments.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring that services meet the necessary coverage criteria. They may have specific local coverage determinations (LCDs) that further define the conditions under which CPT code 36558 is reimbursed. Healthcare providers should consult their respective MAC's guidelines and the current MPFS to ensure compliance and accurate billing for this procedure.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 36558, and by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
