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Coding Corner: Embrace Diversity -- and an Extra $175 -- With Central Venous Access Codes

Age, ports, and pumps divide code groups

You've never had more choices, and more confusion, when reporting central venous access procedures -- thanks to the expanded code list in CPT 2004. Trace these new line placement, catheter, and PICC codes from skin to vein with this expert guidance.
Sail Into Big Bucks With Pumps and Ports
Because of multiple factors -- evolving catheter technology, different amounts of work for different catheter procedures, varying expenses among catheterizations, and the need for better guidance codes -- you now have more catheter and line placement codes, says William T. Thorwarth Jr., MD, member of the CPT editorial board at the American Medical Association's CPT Symposium. These new codes distinguish between devices with ports and/or pumps and allow you more specificity in reporting these procedures.
For example, suppose a patient has advanced breast cancer that has spread to the chest. Her preoperative workup has revealed the presence of bilateral pulmonary nodules, which the physician suspects to be metastatic disease. These results call for him to perform thoracoscopy with a biopsy, and to insert Infusaid for 5-fluorouacil chemotherapy administration. Last year, you would have reported this procedure with 36530 (Insertion of implantable intravenous infusion pump), but now you can report it with 36563 (Insertion of tunneled centrally inserted central venous access device with subcutaneous pump).
Warning: The revamped codes for central line and port placement procedures will require precise physician documentation. The operative notes will need to provide more details than they have in the past: You'll need to know where the catheter was inserted, where it terminates, whether it's tunneled, whether there was a subcutaneous port or pump, and whether guidance modalities were used, says Jackie Miller, RHIA, CPC, a consultant at Per-Se Technologies Consulting Services in Atlanta.
"Having this documentation was less important in the past because there were far fewer choices for the coder," Miller says. "If the catheter was tunneled or if it had a subcutaneous port, it was coded as 36533 regardless of any of the other factors."
This documentation is also important because the codes that include both tunneled devices and ports or pumps earn much more reimbursement, so you'll need to make sure your claims are appropriately supported by details.
The procedures that map to APC 0115 (Cannula/access device procedures), including codes 36560, 36561 and 36563, "require a more expensive device as well as additional time for creation of a subcutaneous pocket," and thus earn nearly $1,400, Miller says. "These devices require two punctures and therefore consume more staff time" than procedures in APC 0032 (Insertion of central venous/ arterial catheter), which only reimburses about $627 -- a difference [...]

- Published on 2004-03-09