Radiology Coding Alert

Question: How should I code the following: Blunt dissection was performed of previously inserted Tessio catheter; removed over guidewire. A dermatotomy was then made and the blunt dissection performed to create a new tunnel. Following passage of the guidewire, a new Tessio catheter was advanced and positioned under fluoroscopy.

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Answer: There are several steps represented in these operative notes, each of which may be reported. The first involves the removal of the previously implanted catheter, which may be billed with 36535 (removal of implantable venous access device, and/or subcutaneous reservoir). Code 36533 (insertion of implantable venous access device, with or without subcutaneous reservoir) should be assigned to describe placement and positioning of the new catheter. You should report the fluoroscopy with 76003 (fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).
 
These procedure codes have a 10-day global period. Therefore, if the Tessio was placed within the previous 10 days, a modifier is needed (e.g., modifier -78, return to the operating room for a related procedure during the postoperative period).