ED Coding and Reimbursement Alert

Question: I’m looking for clarification about whether radiological supervision is required to receive reimbursement for PICC line insertions. I see that the code 36569 speaks to insertion of PICC (we do use imaging guidance, however) and 36584 speaks to all the services included in payment, but I don’t see where it indicates that radiological supervision is mandatory to receive payment. Am I correct in stating that?

Indiana Subscriber

Answer: Yes, according to the details in CPT^® 2021, you are correct. CPT^® clearly states that peripherally inserted central venous catheters (PICC) may be placed with or without imaging guidance. Pick your codes carefully, as some procedure codes in this section bundle imaging guidance.

For example, 36584 (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) bundles all imaging guidance. However, 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) does not include all imaging guidance, and if performed, would be reported separately.