Anesthesia Coding Alert

Know which CPT^® codes to look to for insertion, repair, replacement, and removal.

A triple lumen catheter is a type of central venous catheter that serves as a single point of access to a large vein. This device features three distinct channels (or lumens) within one flexible tube. This allows the provider to administer multiple infusions or do blood draws with only one catheter site. Central inserted catheters can be placed into veins like the jugular, subclavian, femoral, or inferior vena cava.

When coding for these placements, single, double, or triple lumen catheters do not determine the codes used. Coding is determined by whether a catheter is tunneled or non-tunneled, patient age, and if access is through a port or pump. A tunneled catheter is surgically placed with a portion tunneled under the skin. Non-tunneled catheters are placed directly into the vein. Typically, tunneled catheters are for longer term use, while non-tunneled are for short-term use.

Procedures involving these types of catheters fall into five categories, according to the CPT^® 2026 Professional Edition code book:

• Insertion: Newly established access
• Repair: Repair of device without replacement
• Partial replacement: Only catheter component is replaced
• Complete replacement: Entire device
• Removal: Entire device

Know the Codes for Insertion of a Device

Coding for insertion of a device is determined by whether the device is tunneled or non-tunneled and patient age. You’ll choose from the codes below for this service:

• 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age)
• 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older)
• 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age)
• 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older)

Check out These Codes for Repair of a Device

Coding for repair of a device is determined by whether only the catheter is repaired, or the device (port or pump) is repaired. You’ll choose from the codes below for this service:

• 36575 (Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site)
• 36576 (Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site)

Run to These Codes for Device Replacement

There is only one code to consider for partial replacement, as it includes catheter replacement only:

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

Coding for complete replacement is determined by whether the catheter is tunneled or non-tunneled, and whether there is a pump or port. You’ll choose from the codes below for this service:

• 36580 (Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access)
• 36581 (Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access)
• 36582 (Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access)
• 36583 (Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access)

Learn to Code for Removal

Coding for removal is determined by whether there is just a catheter in place or if there is a pump or port present. You’ll choose from the codes below for this service:

• 36589 (Removal of tunneled central venous catheter, without subcutaneous port or pump)
• 36590 (Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion)

If imaging guidance is used, you can sometimes code it separately. Report +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) if ultrasound guidance is used. Report +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)) if fluoroscopic guidance is used. Before using these add-on codes, always check to see if image guidance is included in the code, or if it can be billed separately. 

Understand Anesthesia and Central Venous Catheters

If an anesthesiologist places a central venous catheter during the duration of another procedure, it is not included in the base value and you can code the service in addition to the anesthesia code the provider bills.

If anesthesia is provided (other than local anesthesia) for the placement, repair, replacement, or removal of a central venous catheter or device there are a pair of anesthesia codes that you may consider:

• 00532 (Anesthesia for access to central venous circulation)
• 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified)

Coding for triple lumen catheters comes with the understanding that the number of lumens does not affect code selection. Code selection is determined by the type of catheter (tunneled or non-tunneled), patient age, and whether a port or pump is involved; as well as the specific service performed, such as insertion, repair, partial replacement, complete replacement, or removal. Careful review of documentation as well as CPT^® guidelines is essential for accurate coding to ensure compliance and accurate reimbursement.

Julie McDaniel, MHA, CPC, CANPC, Contributing Writer