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The CPT® Code 36260 refers to the procedure involving the insertion of an implantable intra-arterial infusion pump, which is specifically designed for the administration of chemotherapy directly into the liver. This type of pump is placed subcutaneously, meaning it is implanted beneath the skin, allowing for a more discreet and continuous delivery of medication. The primary use of this infusion pump is in the treatment of metastatic liver cancer, where localized chemotherapy can be more effective than systemic treatment. The procedure begins with a surgical incision made in the right side of the abdomen, below the ribs, to access the abdominal cavity. Once inside, the surgeon evaluates the vascular anatomy to ensure that the hepatic vasculature is normal. If it is, a catheter is inserted into the gastroduodenal artery (GDA), which is a critical step in establishing the infusion pathway. The GDA is then ligated to secure the catheter in place. A separate incision is made to create a subcutaneous pocket for the pump, which is then connected to the catheter. The functionality of the pump is tested using fluorescein dye, and it can be filled with either a chemotherapeutic agent or heparinized saline to prevent clotting. The pump is designed to deliver chemotherapy at a controlled rate over a two-week period, after which the patient returns for a refill. This procedure is essential for patients requiring targeted chemotherapy, as it allows for higher concentrations of the drug to be delivered directly to the tumor site while minimizing systemic exposure.
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The insertion of an implantable intra-arterial infusion pump, as described by CPT® Code 36260, is indicated for patients diagnosed with metastatic liver cancer. This procedure is specifically utilized when there is a need for localized chemotherapy treatment, allowing for direct delivery of chemotherapeutic agents to the liver, which can enhance the effectiveness of the treatment while reducing systemic side effects.
The procedure for the insertion of the implantable intra-arterial infusion pump involves several critical steps to ensure proper placement and functionality of the device.
After the insertion of the implantable intra-arterial infusion pump, patients are typically monitored for any immediate complications related to the surgery. The pump is designed to deliver chemotherapy at a slow, fixed rate over a two-week period. Following this period, patients are required to return to the physician's office for refilling of the pump with the chemotherapeutic agent. It is essential for patients to follow up regularly to ensure the pump is functioning correctly and to address any potential issues that may arise during the treatment process. Additionally, patients should be educated on signs of complications, such as infection or pump malfunction, and instructed on when to seek medical attention.
| Short Descr | INSERTION OF INFUSION PUMP | Medium Descr | INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM | Long Descr | Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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