Venous sheath placement during cardiac cath

[stgregor]

I have a physician who wishes to code for a venous sheath insertion during a cardiac cath. Apparently this is considered a central line placement. Can this be separately coded during a cardiac cath? He has dictated a separate report for the CVP introducer sheath, as below.

PROCEDURE: Introduction of an Arrow CVP introducer sheath, right internal jugular vein.
DESCRIPTION OF PROCEDURE: The right neck was prepped and draped in the usual sterile fashion. The supraclaviculal right internal jugular vein was accessed percutaneously with a Seldinger needle. Through this, an 9 French Arrow introducer sheath was placed into the right internal jugular vein over a J-tip guidewire. Position was confirmed with follow-up chest x-ray.

CONCLUSIONS:
1. Successful insertion of a central line into the right internal jugular vein.
2. No complications.

[lavanyamohan]

Reply-
cannot code venous sheath inserion separately- Cardiac cath codes are sufficient.

[thomasgail]

Can you explain?

[RSammons]

Was it left in for access after the procedure? When I see "sheath" inserted, it makes me think that it was just for the procedure and then removed. Also, if this was an outpatient, in order to code/charge for a non-tunneled central venous access device, you would need the proper C-Code for the central line....if it was a sheath C-Code, then you can't code for a central line.

RSammons, RN, BSN, CIRCC

[theresa.dix@ethc.com]

The cpt code for central nontunneled line is 36555
In order to use this code the catheter tip must reside in the subclavian,innominate or iliac veins,the inferior or superior vena cava or right atrium. I dont see any mention of a catheter being used just a sheath which would be included in the heart cath code.
So im thinking this isnt a central line at all.

[dpeoples]

Originally Posted by stgregor

I have a physician who wishes to code for a venous sheath insertion during a cardiac cath. Apparently this is considered a central line placement. Can this be separately coded during a cardiac cath? He has dictated a separate report for the CVP introducer sheath, as below.

PROCEDURE: Introduction of an Arrow CVP introducer sheath, right internal jugular vein.
DESCRIPTION OF PROCEDURE: The right neck was prepped and draped in the usual sterile fashion. The supraclaviculal right internal jugular vein was accessed percutaneously with a Seldinger needle. Through this, an 9 French Arrow introducer sheath was placed into the right internal jugular vein over a J-tip guidewire. Position was confirmed with follow-up chest x-ray.

CONCLUSIONS:
1. Successful insertion of a central line into the right internal jugular vein.
2. No complications.

With a little more detail/documentation (see Teresa's note above), I would code 36555 or 36556. However, this documentation does not support coding a central line.

HTH