General Surgery Coding Alert

Question: Can we get reimbursed for inserting PICC lines in an acute-care setting? Is there a separate billing from the room charge and normal care given in an acute setting?

Louisiana Subscriber

Answer: Placement of a peripherally inserted central catheter (PICC) line is usually coded as 36489 (placement of a central venous catheter). Code 76000 (fluoroscopy, up to one hour) may also be billed with modifier -26 (professional component) attached if the documentation shows that fluoroscopy was used and identifies what was visualized, says Scott Roberson, CPC, CPC-H, APC, senior compliance coding consultant at Intermountain Health Care, a multispecialty practice in Salt Lake City. He adds that the use of these codes is not restricted in the acute-care setting.

Without seeing an actual bill with these services on it, coders may find difficulty determining what is meant by room charge and normal care. When reporting 36489 on a UB-92, a facility is letting the insurance company know that a PICC line was inserted but is not billing for the procedure. Rather, the facility is billing for the room charge and other overhead (staff time, etc.) associated with the procedure. When CPT 76000 is reported, the facility is letting the payer know what image was taken at the facility and is billing for depreciation of the equipment. Other than any nonroutine supplies and drugs, there should be no other charges on a bill for this service (providing no other services were rendered).