Anesthesia Coding Alert

In the past, partially implanted venous access devices (VAD) were coded as central venous catheters (36488* 36491*). But with the coding modifications now in effect, partially implanted VADs are coded the same as completely implanted VADs (36533, insertion of implantable venous access port, with or without subcutaneous reservoir).

Some new guidelines for coding different devices such as Hickman, PortaCath and Broviac catheters were announced earlier in 1999, and still arent necessarily understood by coders, according to Earl Adair, practice administrator at Holston Anesthesia Group, a physician practice in Kingsport, TN.

Three Categories of VAD

Three types of devices are recognized by CPT:

1. Completely implanted VADs: These are completely subcutaneous (that is, no part of the device protrudes from the skin after insertion).

2. Partially implanted VADs: These include an internal (subcutaneous) portion and an external portion that protrudes from the patients body.

3. Central venous catheters: These may be inserted by using one of several different approaches (subclavian, femoral, internal jugular, etc.). To insert the catheter, an incision is made in the skin, then a short subcutaneous tract is dilated and the catheter is passed through the tract into the vein below. The catheter is inserted through the vein until it reaches the subclavian, brachiocephalic, innominate or iliac vein, or the junction of one of these veins with the superior or inferior vena cava. If the catheter does not reach one of these vessels, it does not qualify as a central catheter.

Central Venous or Partially Implanted?

Many coders get confused about whether to code as a partially implanted VAD or a central venous catheter because at first glance theyre very similar, says Robin Flaugher, a coding specialist at Michiana Anesthesia Care, PC, an anesthesiology practice in South Bend, IN. The main thing to look for is whether a separate skin tunnel is created for the catheter to be placed.

When a central venous catheter is placed (CPT codes 36488*-36491*), a short tunnel, or tract, is created from the skin entry site to where the catheter enters the vein, says Flaugher. When a partially implanted catheter is inserted, creating the tunnel for the catheter is a specific and separate surgical step, not just making a skin incision with tract dilation. The tunnel has to be created before the catheter can be passed through.

The tunnel for a partially implanted VAD is also usually longer than that for a central venous catheter. For example, a typical skin tunnel for a partially implanted VAD can reach from the subclavicular area to [...]