General Surgery Coding Alert

Question: For a 72-year-old male patient, our surgeon removed a non-tunneled central venous catheter through the subclavian vein and replaced it with a Hickman line, which is tunneled. He inserted the new line through the same site, so I looked for a replacement code, but can't find one that describes replacing a non-tunneled catheter with a tunneled catheter. How should I code this?

Arkansas Subscriber

Answer: You should code only the placement of the new line, using code 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older).

Replacement: CPT^® provides the following two replacement codes for central lines

• 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).

As you mentioned, neither of these codes describes removing a non-tunneled centrally inserted central venous catheter with a tunneled catheter.

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).

Again, neither code describes 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 E/M service performed on that date. In your case, removal is included in the new procedure of placing a tunneled central line. That's why you should code just the appropriate insertion code, 36558.