Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Surgery
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 10-01-2012, 01:23 PM
bill2doc bill2doc is offline
Expert
 
Join Date: Apr 2007
Posts: 376
bill2doc is on a distinguished road
Default Hemodialysis catheter insertion CPT HELP !!

Hemodialysis catheter insertion.

The patient developed acute kidney injury and life-threatening hyperkalemia. The decision was made to proceed with hemodialysis. Patient has a right intrajugular transvenous paper and neck was avoided at all costs as to not inadvertently displace the pacemaker. The right femoral vein was targeted. The area was cleaned and draped. With ultrasound guidance, a dialysis catheter was inserted into the right femoral vein on the first attempt via the Seldinger technique and sutured with place. The catheter was then flushed and catheter tips filled with heparin. There were no complications.

Can someone help with the correct CPT please. Thank you !
Reply With Quote
  #2  
Old 10-01-2012, 01:36 PM
cblack712 cblack712 is offline
Guru
 
Join Date: Apr 2007
Posts: 109
cblack712 is on a distinguished road
Default

36556 for non-tunneled placement. I will warn you though that there is room for improvement on this report. If the physician would dictate that patency of the vein was obtained and stored with use of ultrasound you could also use 76937. Without that statement the only billable code on the report is the 36556
Reply With Quote
  #3  
Old 10-01-2012, 02:02 PM
bill2doc bill2doc is offline
Expert
 
Join Date: Apr 2007
Posts: 376
bill2doc is on a distinguished road
Default

Thank you cblack712. The physician did a C-Line insertion, A Line insertion and the above mentioned Dialysis cath insertion. Will I be able to bill for 2 36556 codes? (1 central line) (2 Dialysis cath) ?
Reply With Quote
  #4  
Old 10-01-2012, 02:07 PM
cblack712 cblack712 is offline
Guru
 
Join Date: Apr 2007
Posts: 109
cblack712 is on a distinguished road
Default

With appropriate documentation and either a 78 or 58 mod you should be able to - The insurance will likely require reports for both. Double check your central line placement though and make sure that there is no port and it is not tunneled, that will change the CPT codes
Reply With Quote
  #5  
Old 10-01-2012, 02:12 PM
bill2doc bill2doc is offline
Expert
 
Join Date: Apr 2007
Posts: 376
bill2doc is on a distinguished road
Default

Central line insertion.

INTRODUCTION: The patient required multiple pressor agents and IV drips in an inadequate IV access. An additional central line was indicated. With ultrasound guidance, the femoral vein was targeted. On the first attempt, a triple-lumen catheter was inserted into the left femoral vein via the Seldinger technique and sutured in place. The catheter was flushed and ready for use.


Arterial line insertion.

INTRODUCTION: The patient was hypotensive on multiple pressor agents and precise hemodynamic monitoring was required. The patient also required frequent arterial blood gas sampling and has poor peripheral radial arterial pulsation. An arterial line was, therefore, indicated.

DESCRIPTION OF PROCEDURE: Under ultrasound guidance, the left femoral artery was identified on the first attempt. A femoral arterial catheter was inserted into the left femoral vein on the first attempt via the Seldinger technique. This was attached to an arterial line apparatus where appropriate waveforms were identified. The catheter was then sutured in place and dressing was applied.
Reply With Quote
  #6  
Old 10-01-2012, 02:33 PM
cblack712 cblack712 is offline
Guru
 
Join Date: Apr 2007
Posts: 109
cblack712 is on a distinguished road
Default

Yep. I would use the 78 mod on one of the 36556 since none appear to have the port or are tunneled and def work on getting the doc to verify patency of the selected vein so that you can code the 76937. You are loosing money without that statement being included in the reports.
Reply With Quote
  #7  
Old 10-02-2012, 05:52 AM
bill2doc bill2doc is offline
Expert
 
Join Date: Apr 2007
Posts: 376
bill2doc is on a distinguished road
Default

Will do. Thank you so much!!! I imagine 76937 would need a -26 if able to code.... Thank you again!
Reply With Quote
  #8  
Old 10-02-2012, 05:58 AM
cblack712 cblack712 is offline
Guru
 
Join Date: Apr 2007
Posts: 109
cblack712 is on a distinguished road
Default

Unless you own the equipment than yes, you would need the 26 modifier.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 09:49 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC