Pulmonology Coding Alert

Question: What code can I use to bill for central lines when IV usage is not an option for particular patients? Also, is it ever OK to bill an evaluation and management (E/M) code when doing a central line?

North Carolina Subscriber

Answer: Use 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) for the placement of a central venous catheter in a patient 2 years of age or younger. Use 36489 for the same procedure for a patient over 2 years of age.

Theres no reason for a rejection unless your diagnosis code isnt specific enough to justify to the carrier why an intravenous catheter couldnt be used. Your diagnosis must show a medical necessity for the central line. For example, hypotension (458.9), acute respiratory failure (518.81) or septic shock (785.59) should show medical necessity for a central line to an insurance carrier.

You should not bill a separate E/M code if the physician is already familiar with the patient and knows in advance that a central line is necessary. But if the E/M was performed separately and the central line was used as a result of it, include the E/M code with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show that the service was significant and separate from the central line placement and, therefore, should be reimbursed.

Answered by Rebekah Jonas, coding specialist at the West Texas Medical Association, a multispecialty clinic in San Angelo, Texas.