Radiology Coding Alert

Question: What codes should be used for placement, removal, and repositioning of central venous (PICC) lines when performed by a physician using fluoroscopic or ultrasound guidance?

Anonymous WV Subscriber

Answer: For placement of the central venous catheter the appropriate CPT code is 36488* (placement of central venous catheter [subclavian, jugular, or other vein], percutaneous, age 2 years or under) or 36489* (percutaneous, over age 2). If it is medically necessary to insert the catheter under fluoroscopic guidance, code 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [cardiac fluoroscopy]) could be used. If it is necessary to insert the catheter under ultrasound guidance code 76999 (unlisted ultrasound procedure) could be used. Be sure to document the medical necessity as well as your carriers accepted ICD-9 code.

CPT code 36493 (repositioning of previously placed central venous catheter under fluoroscopic guidance) is the appropriate code to use to report repositioning of a previously placed central venous catheter under fluoroscopic guidance.

The removal of the catheter is included in the E/M service for that day. If it is medically necessary to remove the catheter under fluoroscopic or ultrasound guidance, the appropriate code 76000 or 76999 could be used. Be sure to document the medical necessity.