CPT® Code 36585

Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access

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.