Wiki mal-positioned chemo port with revision

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ollielooya

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Can someone take a look at this and offer some suggestions as to CPT code? Utilizing the index I find 36597 but this does not describe what was done, and no mention
of fluoroscopy. I'm totally puzzled and it probably is easier than I am making it.
Revision of l. internal jugular vein chemo port:
"local aneshtetic was infiltrated into skin overlying the port access pocket. Pocket was opened. The port was noted to be flipped w/hard plastic backing closest to skin.
Port was then secured in place in its intended position w/interrupted 3-0 Prolene suture. Port pocket was then closed w/running 4-0 Monocryl & Dermabond."
 
36576

Wouldn't this be 36576 - repair of central venous access device, with subq port or pump, central or peripheral insertion site? It specifies this is for repair of the device without replacing any parts.
 
Appreciate the responses so far!

I know the page in my CPT book that I'm looking at for the Central Venous Access Procedures Table states to use 36597, but there is no mention in the chart notes about fluoroscopy being used, so this is what is causing my pause---hence the paralysis of analysis!!
 
Still 36576 to me

I say it's definitely not 36597 Repositioning of previously placed central venous catheter under fluoroscopic guidance.

36597 further description: After administration of local anesthesia a needle is inserted. Under fluoroscopic guidance, the catheter tip is repositioned into the proper area. The catheter is left on top of the skin and taped down to prevent movement or removal by accident.
This code is used for repositioning the catheter tip, not the actual port, and specifies fluoro guidance.

36576 further description: When the patient is appropriately prepped and anesthetized, the provider repairs a central venous access device and examines the attached internal access port or pump in the subcutaneous pocket. This tunneled or nontunneled catheter was placed earlier either in a centrally or peripherally located site. He repairs the catheter without actual replacement of any of the defective components of the device. Use this code only when the provider repairs a central venous access catheter with a subcutaneous port or pump that was previously placed.

36576 is the closest to me as it specifies the device, not just the catheter tip. If you feel that's not accurate, then I would advise unlisted. Certainly an unusual case open to debate.
 
Christine, you make a good point, and I've been tossing this scenario back in my mind all day. You are right what you said about the 36597. as it's just not an accurate description of what was done. The extra information you supplied helps, too. I'm totally unfamiliar with this type of situation, can't you tell? Thank you for your input and along with Meghan and taking time from your busy schedules to assist. Perhaps this thread will help others, too!

---Sue
 
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