© Copyright 2025 American Medical Association. All rights reserved.
A peripherally inserted central venous catheter (PICC) is a specialized type of intravenous line that is utilized for the prolonged administration of medications or fluids directly into the bloodstream. The procedure described by CPT® Code 36585 involves the complete replacement of an existing PICC line that includes a subcutaneous port, utilizing the same venous access site. This process begins with a thorough inspection of the current venous access site to ensure its viability for continued use. Following this assessment, the site undergoes a cleansing procedure, and a local anesthetic is administered to minimize discomfort during the replacement process. The existing catheter is then partially removed, leaving a portion still within the vein to facilitate the introduction of the new catheter. The new catheter is prepared by priming it with a flush solution, ensuring it is ready for use. The existing catheter is carefully trimmed to a manageable length, and a hemostat is applied to secure it in place, preventing any unintended migration. An introducer is then advanced into the vein over the trimmed end of the existing catheter, allowing for the complete removal of the old catheter. The new PICC line is inserted through the introducer and advanced into the appropriate central vein, such as the brachiocephalic vein, subclavian vein, or superior vena cava. Once positioned correctly, the PICC is secured with sutures, and a dressing is applied to the insertion site on the arm. This procedure also encompasses all necessary imaging guidance to ensure accurate placement of the new catheter, including documentation, interpretation, and confirmation of the final catheter-tip location. In the case of a complete replacement with a subcutaneous port, the procedure involves opening the subcutaneous pocket, inspecting the port site, and detaching the port from the catheter. The existing catheter is then carefully dissected free from the surrounding tissue, and the new PICC line is inserted as previously described. The placement is verified through separate radiographs, and the new catheter is anchored in the subcutaneous tissue, with the new port being placed in the pocket. Finally, the incision over the venous access site is closed, and the port is sutured into place, completing the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 36585 is indicated for patients requiring long-term venous access for the administration of medications, fluids, or nutritional support. Specific indications for performing a complete replacement of a peripherally inserted central venous access device with a subcutaneous port may include:
The procedure for the complete replacement of a peripherally inserted central venous access device with a subcutaneous port involves several detailed steps:
After the completion of the procedure, the patient is monitored for any immediate complications, such as bleeding or signs of infection at the insertion site. The dressing applied over the insertion site should remain intact and dry, and the patient is advised on how to care for the site to prevent infection. Follow-up imaging may be required to confirm the proper placement of the new catheter and to ensure that it is functioning correctly. Patients are typically instructed to avoid heavy lifting or strenuous activities for a specified period to allow for proper healing. Regular follow-up appointments may be scheduled to assess the catheter's function and the patient's overall condition.
| Short Descr | REPLACE PICVAD CATH | Medium Descr | RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT | Long Descr | Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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 | 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) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 54 - Other vascular catheterization, not heart |
This is a primary code that can be used with these additional add-on codes.
| 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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