Basics of CPT code 36569

A central venous catheter, also called a central line, is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more. In this procedures, a catheter is often inserted in the arm or chest through the skin into a large vein. The catheter is threaded through this vein until it reaches a large vein near the heart. Their are separate procedure codes like CPT code 36569 used for coding central line catheter placement. 

Vascular access procedures are performed when patients need:

• intravenous antibiotic treatment.
• chemotherapy, or anti-cancer drugs.
• long-term intravenous (IV) feeding for nutritional support.
• repeated drawing of blood samples.
• hemodialysis, a process used to treat patients whose kidneys are not working properly. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

Access catheters may also be used for:

• blood transfusions.
• patients who have difficulty receiving a simple IV line.

How to select CPT code 36569

The CPT code involving central venous access devices are divided in 5 categories:

• Insertion (placement of catheter through a newly established venous access)1
• Repair (fixing device without replacement of either catheter or port/pump, other than pharmacologic or mechanical correction of intracatheter or pericatheter occlusion)
• Partial replacement of only the catheter component associated with a port/pump device, but not entire device
• Complete replacement of entire device via same venous access site (complete exchange)
• Removal of entire device

Selecting the correct CPT code from 36555 to 36569 depends on the patient’s age and how the surgeon places the catheter centrally or peripherally, where the catheter tip is at the end of placement, and whether the catheter is tunneled or non-tunneled. Do not choose the procedure code based on catheter name. Surgeons typically place Hickman catheters as central lines, and they usually place them centrally, although they can be tunneled or non-tunneled.

Central – puncture into the jugular, subclavian, femoral vein or in the inferior vena cava.

Peripheral – basilic or cephalic vein.

Read also: Sample coded surgery medical reports for medical coders

Coding guideline for CPT code 36569

As per the CPT coding guideline, in order to qualify as a central venous access catheter or device, “the tip of the catheter/device must terminate in the subclavian, brachiocephalic (innominate), or iliac veins, the superior or inferior vena cava, or the right atrium.” The venous catheter can be inserted centrally (in the jugular, subclavian, femoral vein or inferior vena cava catheter site) or peripherally (via the basilic or cephalic vein). The device may be accessed for use either via exposed catheter (external to the skin), via a subcutaneous port or via a subcutaneous pump.

The procedure codes are divided an the basis of insertion, repair, partial replacement, complete replacement, or the removal of the entire device.

 Here are a few of the determining factors you need to consider to choose the right code:

• insertion (CPT 36555-36573);
• repair (CPT 36575 & 36576);
• partial replacement (CPT 36578);
• complete replacement (CPT 36580-36585);
• removal (CPT 36589-36596);
• tunneled vs. non-tunneled;
• and age of patient: greater or less than 5 years old.

Read also: Coding Selective and Non-Selective catheter placement 

Physician Quality Reporting System (PQRS) for CPT code 36569

Measure 76 Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections

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Sample coded report for CPT code 36569

REASON FOR STUDY:  

Poor venous access, needs multi blood draws.Poss IV treatment

DIAGNOSIS:   Poor venous access.

CONSENT:  

The procedure and possible complications were explained to the patient and written informed consent obtained. Complications include, but are not limited to, bleeding, allergic reactions to injected medications, and infection. While these complications are unusual, they are possible.

PROCEDURE/FINDINGS:  

The procedure was performed by the Interventional Radiology physician. The study was performed in an ACR accredited facility. Medication reconciliation form reviewed and any changes related to this procedure resolved. The patient’s right upper extremity was sterilely prepped and draped. After giving local anesthesia, a 21 gauge needle was used to puncture the brachial vein several cm above the antecubital fossa under ultrasound guidance with a recorded ultrasound image of the patent vessel obtained. Maximal Sterile Barrier Technique was utilized. A 0.018 inch wire was advanced through this into the central veins, as confirmed fluoroscopically. The needle was then exchanged for a peel-away sheath. A 5 French double lumen PICC was cut to an appropriate length of 43 cm and advanced through the peel-away sheath. The sheath was removed. The tip of the PICC was located in the distal SVC/right atrial confluence on final recorded fluoroscopic imaging. The catheter was aspirated and flushed. The catheter was secured to the skin at the exit site.

A sterile dressing was applied. The patient appeared to tolerate the procedure well.

PERFORMED PROCEDURES:  

Upper extremity peripherally-inserted central venous catheter (PICC).

Total fluoroscopy time is 0.2 minutes.

IMPRESSION:  

1. Placement of upper extremity peripherally inserted central venous catheter.

CPT code 36569

Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older

Two CPT codes 36572 & 36573 are used for coding PICC line placement procedures performed with imaging guidance.

36572 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age

36573 – Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older

Hence, the above sample report will be reported with the CPT code 36572 or 36573 depending on the age of the patient. All the imaging guidance, Fluoroscopy (CPT code 77001) & ultrasound guidance (CPT code 76937) will be included in these procedures codes.

CPT code 77001

Fluoroscopic guidance for central venous access device placement, replacement, or removal

CPT code 76937

Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting.

Check the below criteria for assigning Ultrasound guidance CPT code 76937 for PICC Line placement Procedure code 

• Evaluation of potential access sites
• Selected vessel patency
• Concurrent realtime U/S visualization
• Permanent recording and reporting