2025 CPT code 36823
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on Arteries and Veins Surgery Feed
Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation and regional chemotherapy perfusion to an extremity, with or without hyperthermia, including cannula removal and arteriotomy and venotomy site repair.
Modifiers such as 50 (bilateral procedure), 51 (multiple procedures), 59 (distinct procedural service), 76 (repeat procedure by the same physician), and 77 (repeat procedure by another physician) may be applicable depending on the specific circumstances.
Medical necessity for 36823 is established by the presence of a condition requiring isolated limb perfusion, such as locally advanced melanoma or soft tissue sarcoma unsuitable for surgical resection, or a limb-threatening infection unresponsive to systemic therapy.Specific documentation requirements should be confirmed with the payer.
The clinical responsibility includes pre-operative preparation and assessment, cannula insertion and placement, management of extracorporeal circulation, administration of chemotherapy (with or without hyperthermia), cannula removal, and repair of the arteriotomy and venotomy sites. Postoperative care may also be included, depending on payer guidelines.
- Surgery
- Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and Veins
In simple words: This procedure involves placing small tubes (cannulas) into an artery and vein in a limb to temporarily redirect the blood flow.A machine then acts as a temporary heart and lung, allowing high-dose chemotherapy drugs to be delivered directly to the limb to kill cancer cells. This may involve heating the blood.Afterward, the tubes are removed, and the small incisions are closed.
This CPT code encompasses the insertion of one or more cannulas into an artery and vein to establish isolated extracorporeal circulation.The procedure involves diverting the patient's blood through an external device that acts as an artificial lung (oxygenator), enabling regional chemotherapy perfusion to an extremity.This perfusion may or may not include hyperthermia.The procedure concludes with removal of the cannulas and repair of the arteriotomy and venotomy sites.
Example 1: A patient with locally advanced melanoma of the lower extremity undergoes isolated limb perfusion with melphalan and hyperthermia.Code 36823 is used to bill for the cannulation and extracorporeal circulation aspects of the procedure., A patient with recurrent soft tissue sarcoma in the arm undergoes isolated limb perfusion with doxorubicin and regional hyperthermia. Code 36823 is used to report the vascular access and extracorporeal circulation component., A patient with a limb threatening infection refractory to systemic antibiotics undergoes isolated limb perfusion with antibiotics. Code 36823 is reported for the cannulation, extracorporeal circulation and perfusion.
Detailed operative notes describing the cannulation technique, perfusion parameters (flow rates, temperature, drug administration), duration of extracorporeal circulation, and repair of the arteriotomy and venotomy sites.Preoperative and postoperative assessments, including imaging studies (angiograms), should also be documented.
** Code 36823 is typically used in conjunction with other codes to fully represent the services rendered during an isolated limb perfusion procedure.Always refer to the most current CPT manual and payer-specific guidelines for accurate coding.
- Revenue Code: P2F (MAJOR PROCEDURE, CARDIOVASCULAR - OTHER)
- RVU: This information is payer-specific and not included in the provided data.Refer to your specific payer's fee schedule for RVU values.
- Global Days: The global period for this procedure is not specified in the available data.The global period will depend on the specific services provided and may vary by payer.
- Payment Status: Active
- Modifier TC rule: The TC modifier does not apply to this code.
- Fee Schedule: Historical fee schedule data is not provided.Contact your payer for specific historical fee schedule information.
- Specialties:Surgical Oncology, Vascular Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center