Cardiology Coding Alert

Question: The physician removed a non-tunneled central venous catheter through the subclavian vein and replaced it with a tunneled Hickman line for a 50-year-old patient. The physician inserted the new line through the same site. Is there a CPT^® code that describes replacing a non-tunneled catheter with a tunneled catheter?

Florida Subscriber

Answer: In this case, you should report only the placement of the new line with 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older).

Replacement: Although CPT^® provides the following two replacement codes for central lines, neither of these codes describes removing a non-tunneled centrally inserted central venous catheter with a tunneled catheter:

• 36580 (Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access)
• 36581 (Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access).

Removal: CPT^® also provides these two codes for removing a central venous catheter:

• 36589 (Removal of tunneled central venous catheter, without subcutaneous port or pump)
• 36590 (Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion).

However, these codes do not describe your situation of removing a non-tunneled central venous catheter.

Here's why: CPT^® does not provide a code for non-tunneled catheter removal because these access lines are intended to be more short term. Removal is included as part of the follow-up to a procedure, or as part of an evaluation and management (E/M) service performed on that date. In your case, removal is included in the new procedure of placing a tunneled central line. That'swhy you should code just the appropriate insertion code - 36558.