Cardiology Coding Alert

Question: A physician placed a central venous pressure (CVP) line in one of the jugular veins at the beginning of a coronary interventional procedure. The patient had a complete left heart cath provided with a diagnosis of inferior myocardial infarction (MI). Is this CVP line included in the interventional procedure? If not, should I code 36569 for this procedure?

Answer: You can report the CVP line because your cardiologist placed this line in a separate vessel for a separate reason. You stated that the cardiologist placed the CVP line through "one of the jugular veins." The left heart cath is an arterial procedure, meaning the cardiologist performs this through a leg artery. Therefore, the CVP line is separate from the left heart cath.

You have a choice of codes for central lines depending on whether the cardiologist tunneled them. By your choice of 36569, we can assume that the patient is 5 years old or older. If the physician tunneled the catheter, you would use 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older). If the cardiologist did not tunnel the line, use 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older).

But you should not use 36569 (Insertion of peripherally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older). This code is for a peripherally inserted central venous catheter (PICC) line that a physician inserts peripherally, not centrally.