Oncology & Hematology Coding Alert

Question: Is there a new 2008 code that we can use when our hematologist orders peripherally inserted central catheter (PICC) line flushing? I-ve always used 99211 if no other service is billed with it on the same day. Is 96523 applicable? California Subscriber Answer: Code 96523 (Irrigation of implanted venous access device for drug delivery systems) only applies to flushing a completed implanted port -- not PICC flushing. According to CPT Assistant, Spring 1993, there isn't a specific code to report the flushing or maintenance of a PICC line: "There is no CPT code to use to report the periodic maintenance of the catheter or the port. The maintenance of these catheters/ports is generally not performed by a physician. If these maintenance services are performed in a physician's office under the supervision of a physician and are the only service performed that day, code 99211 (Office or other outpatient visit for the E/M of an established patient that may not require the presence of a physician -) may be reported for the maintenance." If the nursing staff performs maintenance of the PICC line (or non-implanted vascular access device) in addition to other services performed on the same day (such as a blood draw from the catheter), there is generally no additional charge. Remember to check individual payer guidelines to see if code 99211 is accepted for this service. Helpful info: Other useful PICC- and port flush-related codes include new 2008 code 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified).