Anesthesia Coding Alert

New codes and categories improve reporting

CPT Codes 2004 includes more than 20 new central venous (CV) access codes, but you can seamlessly replace the old codes with the new - as long as you know the type of access device that the anesthesiologist inserts, the patient's age, and whether the physician used fluoroscopic or ultrasonic guidance to insert it. Look for Centralized Codes in New Section CPT 2004 deleted central venous catheter placement codes 36488-36491 and port-a-cath code 36533, but it added more than 20 new central venous access codes in their place. CPT's new "Central Venous Access Procedures" section centralizes all of these codes and lists them according to the type of service they describe:
  Insertion (codes 36555-36571). Report this series when the physician places a catheter through a newly established venous access.
  Repair (codes 36575 and 36576). Use these codes when the physician fixes the device without replacing the catheter, pump or port.
  Partial replacement (code 36578). Look to this code when the physician replaces the catheter associated with a pump or port - not the entire device.
  Complete replacement (codes 36580-36585). You should report a code from this series when the physician replaces the entire device through the same venous access site.
  Removal (codes 36589 and 36590). Use these codes when the physician removes the entire device. "Previous versions of CPT gave us very limited choices for these procedures," says Tonia Raley, CPC, claims manager for Medical Information Systems in Phoenix. "These new categories help you select the appropriate code for these procedures with regard to repair, replacement and removal." New Groupings Aim for Precision Another plus is that the new groupings help differentiate between catheter techniques that are quite different in terms of the risk involved and work necessary to insert them, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

The section also includes two new codes for mechanical removal of obstructive material (36595, Mechanical removal of pericatheter obstructive material [e.g., fibrin sheath] from central venous device via separate venous access; and 36596, Mechanical removal of intraluminal [intracatheter] obstructive material from central venous device through device lumen). A code for other central venous access procedures (36597, Repositioning of previously placed central venous catheter under fluoroscopic guidance) ends the section. Confirm the Patient's Age Keep these tips in mind when you're searching for the perfect catheter code.
  Many of the codes are distinguished by the patient's age, which helps narrow your choices.
  CPT arranges the subsections according to the type of catheter that the physician uses: non-tunneled and tunneled centrally inserted central venous catheter, tunneled centrally inserted [...]