ED Coding and Reimbursement Alert

Question: Is an external jugular line considered a central line or a central venous-access port by CPT?

New Jersey Subscriber  
Answer: If the external jugular line is a venous-access catheter like those used for central venous pressure, hyperalimentation, hemodialysis or chemotherapy, it would be considered a peripherally inserted central catheter or PICC line. To be a PICC line, the tip of the catheter must be positioned in the central venous circulation, typically the superior vena cava or the junction of the vena cava with the right atrium. These catheters are intended for short- or medium-term use and are often used in ICU patients or for temporary dialysis access. Coders choose among four procedure codes when reporting the insertion of a PICC line, depending on the age of the patient and the approach to the vein:

36488* placement of central venous catheter [subclavian, jugular, or other vein][e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, age 2 years or under
36489* percutaneous, over age 2
36490* cutdown, age 2 years or under
36491* cutdown, over age 2.  
However, if the physician inserts an external jugular line percutaneously for diagnostic studies or intravenous therapy, the line would not be considered a central one, and venipuncture codes 36400-36410 would be used. For an external jugular line to be a central line, the physician must use a J-wire insertion to jump between the external and internal jugular vein. If that procedure is not noted, then the line is a peripheral line. The conversion of an external peripheral jugular line to a central jugular line is complicated and should be fully documented.