In medical coding, we code all type of procedures. These procedures are simple, complex or look complex but are simple. Here, I would consider Central or PICC catheter placement procedures are complex but are very simple to code. I am just going to share my experience about coding these procedures and how to find a correct code for them. Now, when we are talking about interventional radiology we have to talk about guidance as well.

Here also, we have ultrasound 76937 and fluoroscopic 77001-guidance support to perform this procedure. Do not report CPT code 76942 for Vascular procedures as ultrasound guidance. Code 76942 should be used only with non-vascular procedures like biopsy, injection e.g arthrogram, arthrocentesis. So, these two plays a very important role while placing the catheter centrally or peripherally. Now, let us checkout how the whole procedure is performed and how the codes are assigned.

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Procedure performed for Non-tunneled and Tunneled Central Venous Catheter Placement

The initial procedure starts with taking access in a vein. Now, to take access through the vein we have to introduce the needle under ultrasound guidance. The ultrasound guidance helps in checking the patency of the vein, introducing the needle in vein and recording the images. After, taking access in the vein, the catheter is introduced through a guide wire and it is advanced until it reaches to Superior vena cava, inferior vena cava, right atrium, subclavian, brachiocephalic  or iliac vein. After the catheter is placed, images are obtained under fluoroscopic guidance to check the final position of the catheter. The central venous catheter take access in the central vein like internal jugular vein, femoral vein etc. while the peripheral inserted central venous catheter take access in the peripheral vein like basilic vein, cephalic vein etc.

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CPT codes for tunneled and Non-tunneled Central Venous Catheter

The Non-tunneled catheter are not tunneled inside any part of the body, they are just placed outside on the skin to perform the action. Non-tunneled are temporary catheters and are placed for short duration of period. While tunneled catheter are permanent catheters and are little difficult to place, they are placed after creating a tunnel and placing the catheter in the tunnel. The tunneled catheters are not seen when they are placed only the one end of catheter is seen attached to skin. Non-tunneled catheters are thoroughly visible outside the body.

The tunneled catheters are also placed in a subcutaneous pocket or port. These port or pocket held the tunneled catheter inside the body. CPT codes are given for tunneled catheter, which are placed without or with port or pocket. It is very important to understand the difference between tunneled and non-tunneled central venous catheter because the CPT codes in codebook are arranged because of these two terms. In addition, tunneled catheters are very important to learn because they are mostly placed in adults and frequently used in medical coding. The cpt code range from 36555-36571 are used for non-tunneled and tunneled central venous catheter.

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ICD 10 code for Tunneled Central Venous Catheter CPT codes

Z45.2 -Encounter for adjustment and management of vascular access device

Common mistakes with Tunneled Central Venous Catheter CPT codes

The first error mostly we do, not to check the vein accessed whether it is central or peripheral, this will always lead t us to wrong code. Codes are arranged in Central or Peripheral inserted catheter hence we should always check for the vein accessed for procedure.

Always check for the age of the patient. This may be not common, but an overlook error considering always an adult. Sometimes it may be a newborn or age less than 5 years. It is very important to know the procedure performed on young patients have a high dollar value than adults. So, do not make a mistake of giving wrong code for patient less than 5 years, it will highly affect the payment.

This error very common and even I have done it in my past. The tip of catheter is always to be check and placed in SVC, IVC or innominate artery. If the catheter is not placed in the Superior vena cava, inferior vena cava, right atrium, subclavian, brachiocephalic  or iliac vein, then it is considered as a reduced service and then the procedure will be coded with 52 modifier. Always, check the final position of the catheter to code the correct CPT code.

Do not forget to use guidance code along with main procedure code. Ultrasound 76937 and fluoroscopic guidance 77001 are necessary to perform with these procedures. Missing any of these guidance codes will affect the payment of the procedure.

Below CPT codes should be used for PICC line placement. CPT code 36568 are used for exam done without imaging guidance. If imaging guidance is used then report CPT 36572 and 36573.

36568 -Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age

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 – age 5 years or older

Code 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

For codes 36572, 36573, and 36584, all image documentation and radiological supervision and interpretation (RS&I) are included and required to report the procedures. When ultrasound guidance is performed, the following should be documented:

• Evaluation of the potential puncture sites
• Patency of the entry vein
• Real-time ultrasound visualization of needle entry into the vein; and

Image documentation (representative images from all modalities used are stored to patient’s permanent record).

Note: that imaging to document the final catheter position or to confirm location of the catheter tip is not reported separately because all necessary imaging is included in codes 36572, 36573, and 36584.

If confirmation of the catheter-tip location is not performed by the physician or other qualified health care professional performing the PICC insertion or replacement, then codes 36572, 36573, and 36584 are reported with modifier 52 appended to reflect reduction in service.