CPT® Code 36565

Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter)

The CPT® Code 36565 refers to the procedure of inserting a tunneled centrally inserted central venous access device (CVC) that requires the placement of two catheters through two separate venous access sites. This procedure is performed without the use of a subcutaneous port or pump, such as a Tesio type catheter. A central venous catheter is a long, thin tube that is inserted into a large vein in the body, typically terminating in major veins such as the subclavian, brachiocephalic, or iliac veins, or in the superior or inferior vena cava, or right atrium. The tunneled CVC is specifically designed to be placed through a subcutaneous tunnel, which allows for the catheter to be inserted into veins like the jugular, subclavian, or femoral vein, with the jugular vein being the most commonly used access site for these devices. The procedure typically involves the use of local anesthesia at the puncture site and may include imaging guidance to assist in accessing the venous entry site and positioning the catheter tip correctly. The Seldinger technique is commonly employed for this procedure, which involves puncturing the skin and vein with a needle, followed by the insertion of a guidewire. An incision is made to create a subcutaneous tunnel, allowing for the catheter to be advanced into the appropriate vein. The procedure concludes with the catheter being secured and the incision site being closed and dressed appropriately. This code specifically denotes the insertion of two tunneled CVCs without any connection to a subcutaneous port or pump, distinguishing it from similar procedures that may involve such connections.