Pulmonology Coding Alert

Question: A pulmonologist places a central line and a Swan-Ganz catheter. Should I bill for both procedures?


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Answer: You should usually include the central line insertion (for example, 36555, Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age) in the Swan-Ganz catheter insertion (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). Because the pulmonologist cannot place the Swan-Ganz without inserting a central line, the Swan-Ganz catheter insertion includes the access to the central venous system.

Exception: If the pulmonologist puts in another central line after inserting the catheter, you can report a central line code, such as 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age). To show that your pulmonologist performed the central line insertion separately from the Swan-Ganz procedure, you should attach modifier 59 (Distinct procedural service) to 36557.