Anesthesia Coding Alert

Question: Our anesthesiologist placed a catheter to use during a patient's dialysis treatment (36489*, Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2 was used). Then the catheter was removed due to infection. How can the anesthesiologist's services be billed? Missouri Subscriber Answer: The placement of a dialysis catheter is not generally reported with 36488* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, age 2 years or under) or 36489*. The descriptors state "dialysis," but most dialysis catheters have a port or reservoir or are considered implantable devices and should be billed with 36533 (Insertion of implantable venous access device, with or without subcutaneous reservoir) instead. This crosses to code 00532 (Anesthesia for access to central venous circulation); the codes for revision and removal of a catheter (36534, Revision of implantable venous access device, and/or subcutaneous reservoir; and 36535, Removal of implantable venous access device, and/or subcutaneous reservoir) also cross to anesthesia code 00532.

Removal of a central line usually does not require anesthesia, but it can be billed if extenuating circumstances merit it. In that case, anesthesia code 01844 (Anesthesia for vascular shunt, or shunt revision, any type [e.g., dialysis]) could be used since the descriptor is for "any type" (i.e., dialysis). Submit it with supporting documentation and include modifier -23 (Unusual anesthesia) to alert the carrier that this may be an unusual case they should check closely instead of automatically denying it as not medically necessary.