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The procedure described by CPT® Code 36450 refers to an exchange transfusion specifically performed on newborns. This medical intervention is critical in managing conditions such as hemolytic disease of the newborn, where the infant's blood may contain high levels of bilirubin or other harmful substances. The exchange transfusion process involves the careful removal of the infant's blood and simultaneous replacement with donor blood, which helps to reduce the concentration of these harmful elements in the newborn's bloodstream. The procedure can be executed using either a one or two catheter push-pull technique, depending on the clinical scenario and the physician's preference. In the two catheter technique, a specific artery and vein are selected to facilitate the exchange, ensuring that blood is withdrawn from the artery while donor blood is infused through the vein at the same rate. Alternatively, the one catheter technique typically utilizes an umbilical vein or, less commonly, an umbilical artery catheter. The placement of the catheter is crucial and is verified through radiographic imaging to confirm that it is correctly positioned in the inferior vena cava or right atrium. This meticulous approach allows for the effective exchange of blood, with the goal of replacing a significant volume of the newborn's blood to improve their overall health and reduce the risk of complications associated with their condition.
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The exchange transfusion procedure described by CPT® Code 36450 is indicated for specific clinical conditions in newborns that necessitate the removal of harmful substances from the bloodstream. These indications include:
The exchange transfusion procedure involves several critical steps to ensure the safe and effective exchange of blood in a newborn. The steps are as follows:
After the exchange transfusion is completed, the newborn is closely monitored for any potential complications or adverse reactions. This includes observing vital signs, assessing the infant's overall condition, and ensuring that the catheter is removed safely if it was used. The healthcare team may also perform follow-up blood tests to evaluate the effectiveness of the transfusion and to monitor bilirubin levels. Supportive care may be provided as needed, and the infant's response to the procedure is carefully documented to inform ongoing treatment and management.
| Short Descr | BLD EXCHANGE TRUJ NEWBORN | Medium Descr | BLOOD EXCHANGE TRANSFUSION NEWBORN | Long Descr | Exchange transfusion, blood; newborn | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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) | 0 - 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 | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 222 - Blood transfusion |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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| 2024-01-01 | Changed | Short and Medium Descriptions changed. |
| 2021-01-01 | Note | Guidelines changed. |
| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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