Radiology Coding Alert

Think age doesn't matter? New CV access codes say otherwise CPT Codes 2004 includes over 20 new central venous (CV) access codes, but you can seamlessly replace the old codes with the new - as long as you know the type of access device that the radiologist inserted, the patient's age, and whether the physician used ultrasound or fluoroscopic guidance during the insertion. The AMA revised the CV access codes for several reasons, including evolving technology with new catheter types and the need for appropriately valued guidance codes, says William T. Thorwarth Jr., MD, CPT editorial panel member, who spoke about the new CV access codes at the AMA's CPT Symposium in November 2003. The following three tips will help you select the appropriate CV access code every time. 1. Determine What Type of Catheter the Physician Inserted. A quick perusal of CPT 2004 offers two full pages of CV access insertion codes. To narrow down your code choice, determine whether the physician inserted a tunneled catheter, a nontunneled device or a peripherally inserted central venous catheter (PICC), and whether he used a subcutaneous port or pump during the procedure. When the radiologist places the line percutaneously for short-term use, he probably uses a nontunneled catheter (36555-36556). If, however, the physician intends to use the line for prolonged periods, tunneling the catheter under the skin adds a bit of work to the procedure but also makes it more difficult for bacteria to migrate along the catheter into the blood stream. The term "subcutaneous port" means that the whole catheter, including the point of access, is under the skin and is less likely to get contaminated. The tunneled catheter insertion codes are 36557-36566. You should never assume that the inserted device is tunneled or nontunneled, and with or without a subcutaneous port or pump. The procedural report should explicitly state what the physician inserted. Physicians normally insert PICC lines through a peripheral vein and then negotiate them into the central venous circulation rather than inserting them directly into a central vein. You should report 36568-36569 for externally accessible PICC line insertion, and 36570-36571 for peripherally inserted central venous access devices with subcutaneous ports. "In the past," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb., "there was only really one choice of codes for placement of either centrally inserted or peripherally inserted lines. The emphasis on outpatient care has led to more and more use of PICC lines, and having codes to describe this work will be very valuable." And don't bother looking for a PICC line removal code when the patient no longer needs that temporary access line. "There's no removal code for [...]