Radiology Coding Alert

Many professional coders report confusion about how to code implantation of venous access ports (36533), as opposed to placement of central venous catheters (36488-36491). Although the two procedures are very different, coders indicate that they often have a hard time distinguishing what code to use for each service.

Part of the challenge is recognizing what each procedure entails and what types of devices are used. In addition, coders must work closely with interventional radiologists to ensure that documentation clearly reflects the level of work conducted.

Learning the differences between the procedures also is crucial because they are reimbursed at highly disparate levels, coding experts note. For instance, 36533 has 10.28 relative value units (RVUs), while 36489 is reimbursed at less than a third of that, at 3.13 RVUs.

How to Code Central Venous Catheters

Generally speaking, the less complex of the two procedures is the placement of central venous catheters, often referred to as central or peripherally inserted central catheter lines (PICC), says Kathleen Mueller, RN, CPC, CCS-P, an independent coding and reimbursement consultant and educator based in Lenzburg, Ill. To be classified as a central line, the catheter must be placed ultimately in the subclavian, brachiocephalic, innominate or iliac veins, or the junction where one of these veins joins the superior or inferior vena cava. This category of service also includes placement of triple-lumen catheters and temporary subclavian or femoral venous lines, such as those used in intensive care unit patients or for temporary dialysis access. These catheters are intended for short- or medium-term use.

Codes used for central venous catheter placement are:

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;
36489 ... percutaneous, over age 2;
CPT 36490 ... cutdown, age 2 years or under; and
36491 ... cutdown, over age 2.

Coding for this procedure depends on the age of the patient and the approach to the vein, according to Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. Codes 36488 and 36489 are percutaneous codes, but 36490 and 36491 are identified as cutdown codes, in which the selected vein can be seen through the incision. In addition, 36488 and 36490 are assigned for procedures on patients 2 years old or younger depending on the approach, but 36489 and 36491 are reported for patients older than 2.

During the procedure, [...]