Anesthesia Coding Alert

Question: Which code is appropriate for removing a central venous (CVP) line when it is done by the anesthesiologist provider?

Florida Subscriber

Answer: Removing a central venous line does not require the skills of a physician unless the patient is heavily anticoagulated or suffering another problem such as combativeness that would necessitate the presence of a physician. There is no code for the removal of a CVP, endotracheal tube or Foley catheter. In a hospital, nursing staff can handle these procedures. Insurers will want to pay for services that are included in the hospitals charge just because a physician does it. If you are called to remove a CVP line for a medical indication (i.e., anticoagulation), then a consult code could be billed dealing with the risks and benefits of pulling the line now or later, and the need for reversal of anticoagulation.

Two appropriate consult codes in this situation could be 99231 (subsequent hospital care, per day, for the E/M of a patient, which requires at least two of these three key components: a problem-focused interval history, a problem-focused examination, and medical decision- making that is straightforward or of low complexity) or 99221 (initial hospital care, per day, for the E/M of a patient which requires these three key components: a detailed or comprehensive history, a detailed or comprehensive examination, and medical decision-making that is straightforward or of low complexity) if this is a new patient. There are no carriers that reimburse the provider for the physical act of pulling a CVP.