Anesthesia Coding Alert

Verify uses before filing that next claim--or face denials

Although the global anesthesia code includes fees for most services, you can often bill separately for line placements. If your anesthesiologist frequently establishes central venous or pulmonary artery catheters, follow our experts' advice on when to separately code the lines--and when you can only report one of them. Look for CVPs With Extensive Vascular Cases The anesthesiologist monitors central venous pressure by inserting a central venous pressure (CVP) line into the patient's superior vena cava. Your physician also uses the line to gain IV access and monitor--and possibly adjust--the patient's blood volume. Or the physician may use a

CVP for central drug infusion during procedures that usually include fluid shifts (such as during a renal transplant case to ensure adequate hydration for the transplanted kidney).

Many abdominal, cardiothoracic or other extensive vascular cases generally include CVP line placement. Using CVP lines allows the anesthesiologist to directly administer medications into central circulation for the best effect, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. Narrow Your CVP Coding Options Years ago, CPT listed only two CVP codes. CPT 2004 changed that, however, with its complete revamping of all line placement and removal codes. Now several codes apply to CVP lines, based on the type of device your physician uses, the patient's age, and the placement technique:

• 36555-36556--Insertion of non-tunneled centrally inserted central venous catheter ...

• 36557-36558--Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump ...

• 36560-36561--Insertion of tunneled centrally inserted central venous access device, with subcutaneous port ...

• 36563--Insertion of tunneled centrally inserted central venous access device with subcutaneous pump

• 36565-36566--Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; without subcutaneous port or pump (e.g., Tesio type catheter); and ... with subcutaneous port(s)

• 36568-36569--Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump ...

• 36570-36571--Insertion of peripherally inserted central venous access device, with subcutaneous port ...

Common choices: Even with so many codes to choose from, Johnson says, you probably find yourself returning to the same ones, depending on your physicians' typical services.

"This is true," says Kelly Dennis, CPC, ACS-P, PMCC, owner of Perfect Office Solutions in Leesburg, Fla. "In many cases, the anesthesiologist will place a non-tunneled catheter and the surgeon will place the tunneled--which means you'll report the non-tunneled codes."

Explanation: Anesthesiologists tend to insert temporary CVP lines that will be removed during the perioperative period. A surgeon usually tunnels longer-term CVPs to prevent infection, such as those used for months of chemotherapy treatment.

Companion codes for CVP line placement describe line repair (36575-36576), replacement (36578-36585) and removal [...]