CPT Code 36590: Removal of Tunneled Central Venous Catheter Without Subcutaneous Port or Pump

What is tunneled central venous catheter removal?

Tunneled central venous catheter (CVC) removal, reported under CPT code 36590, refers to the removal procedure of a central venous access device that does not have a subcutaneous pump or port.

This procedure involves carefully extracting the catheter that was previously tunneled beneath the skin for long-term vascular access, often used for chemotherapy, dialysis, or parenteral nutrition. Performed by a qualified health care professional, it requires documentation that distinguishes it from procedures involving a device with a subcutaneous port or pump, central or peripheral insertion.

CPT code 36590, which pertains when a tunneled central venous catheter is removed as a standalone procedure, and the proper coding process ensures accurate Medicare reimbursement, especially when done during the postoperative period or on the same day as other services.

Documentation requirements

Documentation must include:

• Indication for catheter removal (e.g., infection, catheter malfunction, end of treatment)
• Description of the catheter confirming it is a tunneled central venous catheter without a subcutaneous port or pump
• Details of the procedural technique, such as incision, dissection, or traction used during the removal procedure
• Anesthesia used and the patient's tolerance of the procedure
• Method of hemostasis and wound closure
• Any post-procedure instructions provided to the patient

These details help healthcare providers accurately document the procedure performed, ensure proper reimbursement, and avoid claim denials when billing Medicare or other insurance payers.

Billing guidelines

• Do not report CPT code 36590 for removal of a device with a subcutaneous port or pump—instead, use CPT codes 36589 (removal of tunneled central venous catheter with port) or 36595 (mechanical removal with separate procedure).
• The code includes local anesthesia and basic wound care; these are not separately billable.
• Fluoroscopy (e.g., 77001) may be reported separately if it is medically necessary and documented.
• Do not report an E/M service on the same day unless it is unrelated to the removal procedure and supported by separate documentation.
• Ensure the device is accurately described as a tunneled central venous catheter without subcutaneous port, to avoid confusion with central venous access devices that include ports or pumps.

These billing practices enable healthcare providers, coders, and medical billing services to maintain accurate coding, support proper reimbursement, and comply with directives from medicare administrative contractors (MACs) and the national correct coding initiative (NCCI).

Other related CPT codes

• 36589 – Removal of tunneled catheter with subcutaneous port
• 36596 – Mechanical removal of catheter (e.g., sheath)
• 36598 – Contrast injection for catheter evaluation