Cardiology Coding Alert

Hint: Never report 36584 in conjunction with +76937 or +77001.

You learned about the CPT^® 2019 new and revised peripherally inserted central venous catheter (PICC) codes in Cardiology Coding Alert Vol. 21, No. 10. Getting ready for these revisions and additions, which go into effect on Jan. 1, 2019, is vital to submitting clean claims.

To prepare for these new changes, coders should always be aware of what is currently going on in the coding world. You can do this by reading current newsletters, using free available coding forums and multiple free websites that offer current coding news, and networking with other coders, explains Carol Hodge, CPC, CDEO, CCC, CEMC,  certified medical coder at St. Joseph’s Cardiology in Savannah, Georgia.

Not only should you prep for these new PICC codes, but you must also learn the new guidelines that go along with the codes. Read on to learn how you can painlessly apply these new PICC guidelines in your cardiology practice.

Follow These Handy Tips to Correctly Report 36572, 36573, and 36584

Additions: “Two new CPT^® codes (36572 and 36573) were created to describe PICC line procedures that bundle imaging guidance, image documentation and all associated radiological supervision and interpretation,” says Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska.

Take a closer look at new codes 36572 and 36573:

• 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age)
• 36573 (… age 5 years or older).

Code 36584 revision: CPT^® also revised PICC code 36584. The revised descriptor now reads, with emphasis added, (Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement).

As you can see, 36584’s descriptor now includes all imaging guidance, image documentation, and all associate radiological supervision and interpretation the cardiologist needs to perform the PICC replacement.

Tips: Through the guidelines and parenthetical notes, CPT^® identifies specific rules you should follow when reporting 36572, 36573, and 36584. Follow these tips to keep your PICC claims in tip-top shape:

• Tip 1: You should never report 71045 (Radiologic examination, chest; single view) through 71048 (… 4 or more views) to document the final catheter position on the same day of service as 36572, 36573, or 36584.
• Tip 2: Since 36572, 36573, and 36584 include confirmation of the catheter tip location, the cardiologist who reports image-guided PICC insertion cannot report the confirmation of the catheter tip location separately.
• Tip 3: If the cardiologist performs a 36572, 36573, or 36584 service but does not confirm the catheter tip’s location, then you should append modifier 52 (Reduced services) to the appropriate code.
• Tip 4: Never report 36572 or 36573 in conjunction with +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) or +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)).
• Tip 4: Never report 36584 in conjunction with +76937 or +77001.

Dig Into These 36568, 36569 Revisions

Don’t miss these PICC code descriptor revisions. (Additions are underlined for emphasis.)

• 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
• 36569 (… age 5 years or older)

As you can see by the descriptors, you should report 36568 or 36569 only when the cardiologist performs PICC placement without imaging guidance.

Don’t miss: If the cardiologist places PICCs by using “magnetic guidance or any other guidance modality that does not include imaging or image documentation,” then you should also report 36568 or 36569, per the CPT^® guidelines.

Also, you should never report 36568 or 36569 in conjunction with +76937 or +77001, according to CPT^® guidelines.

Pay Close Attention To Parenthetical Notes, Documentation

It’s so important to pay close attention to the medical documentation and to read code descriptors carefully when reporting PICC services. Codes 36568, 36569, 36572, 36573, and 36584 all have parenthetical notes under them in the CPT^® manual to remind you of this.

For example, a note under 36572 tells you to report 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age) for the placement of a centrally inserted non-tunneled central venous catheter, without subcutaneous port or pump, for a patient who is younger than 5 years old. The important distinction here is that you would report 36572 for the insertion of a PICC, and you would report 36555 for the insertion of a non-tunneled centrally inserted central venous catheter. So, you must know what the documentation says about the type of catheter the cardiologist inserted.

Age is also important: Make sure you also know the patient’s age. For example, you would report 36572 for a patient who is younger than 5 years old. On the other hand, you would report 36573 for a patient who is 5 or older.

Don’t Mix Up Midline Catheters With PICCs

You should never confuse midline catheters, which “terminate in the peripheral venous system” with PICCs, according to CPT^® guidelines. Midline catheters “are not central venous access devices and may not be reported as a PICC service,” the guidelines emphasize.

Instead, when a cardiologist performs a midline catheter placement, you should report codes 36400 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein); 36405 (… scalp vein); or 36410 (Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)), according to the guidelines.