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Coding Corner: Access Flawless PICC Coding

Hint: Catheter type governs correct PV reporting

Confused about when to report which central venous access codes? Smooth out your PICC troubles with these expert tips.
Choose the Correct Catheter
The first distinction you need to make to select the correct access code is what kind of catheter the physician inserted. Narrow down your code choice by determining whether the catheter was tunneled, nontunneled, or peripherally inserted, and whether he used a subcutaneous port or pump. For these procedures, you'll use codes 36555-36590, says Laura Henshaw, coder at Holy Family Memorial Medical Center in Manitowoc, Wis.
CPT establishes that central venous access catheters or devices must terminate in the "subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena cava, or the right atrium," says Jim Collins, CPC, ACS-CA, CHCC, president of Compliant MD Inc. in Matthews, N.C. To be considered a central insertion, the access site (where the catheter enters the vascular system) must be in an artery close to the central circulatory system, including the jugular, subclavian, femoral vein, or inferior vena cava, Collins says.
Access sites for peripherally inserted catheters, on the other hand, could include the basilica or cephalic vein, he says.
Short term: When the doctor places the line percutaneously and intends only short-term use, he'll probably insert a nontunneled catheter. For this type of device, you'll report either 36555 (Insertion of nontunneled centrally inserted central venous catheter; under 5 years of age) or 36556 (...age 5 years or older).
Long term: If the physician wants to use the catheter for longer periods of time, he'll most likely insert a tunneled catheter. Tunneled catheter insertion is a more difficult procedure, but is better at keeping bacteria out of the catheter (and thus out of the patient's bloodstream). For these procedures, you'll report one of these codes:

  36557 - Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; under 5 years of age

  36558 - ...age 5 years or older

  36560 - Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; under 5 years of age

  36561 - ...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 two catheters via two separate venous access sites; without subcutaneous port or pump

  36566 - ...with subcutaneous port(s).
Depending on where in the facility the physician performs the procedure, you will either report the service with operating room revenue codes (0360 or 0361) or emergency room revenue codes (0450 or 0451), Henshaw says.
PICC Catheter Insertion Point
Use PICC codes when the physician inserts a line through a [...]

- Published on 2005-04-13