What is Central Venous Catheter?
For patients who are getting frequent injections or are under chemotherapy, the physicians recommends a central line or central venous catheter(CVCs) . CVCs are also called as venous access device. Central Venous catheter are inserted through the forearm or the chest and the tip of the catheter will lie close to heart, to its large vein called Superior Vena Cava. A central venous catheter is placed in neck in large vein like internal jugular vein or in the chest like subclavein vein or axillary vein or in groin like femoral vein. So, these catheters can be kept for a long duration and physician can give medication or take out blood sample whenever required without repeatedly poking your veins. There are generally three type of central venous catheter.
Peripheral Inserted Catheters (PICCs)
Implanted port Catheters.
Tunneled Central Venous Catheter
Tunneled catheters are inserted under the skin from the insertion site to a separate exit site. Tunneled Catheters are prevented from getting infected and also provides stability. Tunneled catheters are also called Permanent Catheters. Commonly used tunneled catheters include Hickman catheters and Groshong catheters.
Peripheral Inserted Catheters (PICCs)
Peripheral inserted catheter are inserted peripherally in forearm vein. Central venous catheter are inserted in vein of neck or chest centrally. PICCs are inserted vein of arm and the tip of the catheter is located in the superior vena cava.
Implanted Port Catheters
These are also called Port-A-Catheters. A small device to which catheter is attached is called port. A subcutaneous pocket is created to place a port attached with catheter underneath the skin. Implanted port catheters are similar like tunneled central venous catheter but they are completely located beneath the skin.
Read also: Selective and Non-Selective catheterization coding rules
CPT codes for Central venous Catheter Placement (36555 to 36569)
Coding of Central Venous Catheter Placement are mainly based on
- Age of the patient
- Non-tunneled or Tunneled Catheters
- With or without Implanted Port catheters.
Now, if you know all these three measures, you can easily reach to the correct code.
Also, along with these codes, we have to use guidance codes. Ultrasound and Fluoroscopic guidance are the most common codes used to code with Central venous catheter placement codes.
Fluoroscopic guidance code is coded as 77001. Fluoroscopic guidance is used to determine the for the proper placement of the tip of the catheter.
Ultrasound guidance is coded as 76937. This cpt is coded only when it qualifies for three measures
- Patency of the blood vessel i.e. Vein
- Catheter is inserted under Ultrasound guidance.
- Images should be recorded.
So, if you have to code 76937, these three thing should be mention to code this cpt.
So, when a central venous catheter is placed, first the patency of vessel is documented. Then, the catheter is inserted under ultrasound guidance. Once, the catheter tip reached to superior vena cava images are recorded. Finally, catheter position is confirmed under Fluoroscopic guidance. So, we will land up with three codes, first code will be from series 36555-36569, followed by guidance codes 76937, 77001.
Read also: When to use lung ventilation and perfusion scan CPT codes
Physician Quality Reporting System (PQRS) for CPT code 36569
Measure 76 Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections
| CPT Codes | |||
| Code | Modifier | POS | Description |
| 36555 | Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age | ||
| 36556 | Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older | ||
| 36557 | Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age | ||
| 36558 | Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older | ||
| 36560 | Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age | ||
| 36561 | Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older | ||
| 36563 | Insertion of tunneled centrally inserted central venous access device with subcutaneous pump | ||
| 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) | ||
| 36566 | Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s) | ||
| 36568 | Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age (revised 2019) | ||
| 36569 | Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older (revised 2019) | ||
| 36570 | Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age | ||
| 36571 | Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older | ||
| 36578 | Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site | ||
| 36580 | Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access | ||
| 36581 | Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access | ||
| 36582 | Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access | ||
| 36583 | Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access | ||
| 36584 | Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement (revised 2019) | ||
| 36585 | Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access | ||
| 93503 | Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes | ||
| 6030F | All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT) | ||
| 6030F | 8P | All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT) | |
| 6030F | 1P | All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT) | |
| 6030F | All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT) | ||
| 6030F | 8P | All elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed (CRIT) | |
Hope, this will give a short knowledge about central venous catheter placement cpt codes. Please share if you like my article. Feel free to comment or any suggestion regarding my blog.