© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 36591 refers to the procedure of collecting a blood specimen from a completely implantable venous access device (IVAD). An IVAD is a medical device that allows for easy access to the venous system for the administration of medications, fluids, or for blood draws. The procedure begins with the identification of the IVAD's septum, which is located by palpating the skin over the device. This is a critical step to ensure accurate needle placement. Once located, the skin is cleansed to reduce the risk of infection. A specialized needle known as a Huber needle, which is designed with a side hole to facilitate blood collection, is then inserted into the IVAD at a precise 90-degree angle. This angle is important to ensure that the needle properly accesses the internal reservoir of the IVAD. After the initial blood aspiration, the device is flushed with normal saline to maintain patency and prevent clot formation. The procedure involves careful handling of the extension tubing and the use of a Vacutainer system to collect the blood specimen efficiently. The process may involve multiple blood specimen tubes, and proper flushing with saline and heparin is performed to ensure the IVAD remains functional for future use. This detailed approach is essential for maintaining the integrity of the IVAD and ensuring accurate blood specimen collection.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 36591 is indicated for the collection of blood specimens from patients who have a completely implantable venous access device (IVAD). This procedure is typically performed in situations where blood tests are required for diagnostic purposes, monitoring of medical conditions, or evaluation of treatment efficacy. The use of an IVAD allows for repeated access to the venous system without the need for repeated venipunctures, making it particularly beneficial for patients undergoing long-term treatment, such as chemotherapy or those with chronic illnesses requiring frequent blood draws.
The procedure for collecting a blood specimen from a completely implantable venous access device (IVAD) involves several critical steps to ensure accuracy and safety. First, the healthcare provider locates the septum of the IVAD by palpating the skin over the device. This step is essential for proper needle insertion. Once the septum is identified, the skin is cleansed thoroughly to minimize the risk of infection. Following this, a Huber needle, which is specifically designed for accessing IVADs, is prepared. The needle is attached to a syringe and extension tubing that has been primed with normal saline. The Huber needle is then inserted into the IVAD at a 90-degree angle, allowing for direct access to the device's reservoir. After insertion, a small amount of blood is aspirated into the syringe to ensure proper access and to check for blood return. The IVAD is then flushed with normal saline to maintain its patency. Next, the extension tubing is clamped to prevent backflow. The syringe is disconnected from the Huber needle, and an intermittent injection cap is attached to the extension tubing. A Vacutainer is then inserted into the injection cap, followed by a discard tube onto the Vacutainer needle. The tubing is unclamped, allowing the discard tube to fill, which is then removed and discarded to ensure that any potential contaminants are not included in the specimen. After this, a blood specimen tube is attached to the Vacutainer needle, and the extension tubing is unclamped again to collect the blood specimen. This process may be repeated to fill one or more blood specimen tubes as needed. Once the required specimens are collected, the Vacutainer is removed, and the line is flushed with 20 ml of normal saline to clear the IVAD. If no further procedures, such as medication infusion, are planned, the syringe is disconnected, and the extension tubing is flushed with heparin to prevent clotting. Finally, the Huber needle is carefully removed from the IVAD, completing the procedure.
After the procedure is completed, it is essential to monitor the site of the IVAD for any signs of complications, such as bleeding, infection, or discomfort. The patient may be advised to keep the area clean and dry, and to report any unusual symptoms to their healthcare provider. If the IVAD is to be used for future procedures, proper care and maintenance should be followed to ensure its continued functionality. The healthcare provider may also document the procedure details in the patient's medical record, including the amount of blood collected and any observations made during the procedure. Follow-up appointments may be scheduled as necessary to assess the patient's condition and the status of the IVAD.
| Short Descr | DRAW BLOOD OFF VENOUS DEVICE | Medium Descr | COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE | Long Descr | Collection of blood specimen from a completely implantable venous access device | Status Code | Injection | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 3 - Technical Component Only Code | Multiple Procedures (51) | 0 - No 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 | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 63 - Other non-OR therapeutic cardiovascular procedures |
| Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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. | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | AG | Primary physician | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | JZ | Zero drug amount discarded/not administered to any patient | KV | Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service | LT | Left side (used to identify procedures performed on the left side of the body) | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2011-01-01 | Changed | Guideline information changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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