Central Venous Line Placement

Trendale

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Hello,
I need help coding this. I beleive it is 36556. Should I code the ultrasound as well? How do you determine if it is tunneled or non-tunneled?

Indication: Hypotensive. Venous access needed for vasopressor infusion
( what dx would I use for that?)

There was exaggerated distention of the external juglar and veins of the head and neck. Using the sonosite ultrasound, the right IJ was easily identified and the carotid artery was easily identified. The patient was then prepped and draped in the usual sterile fashion. Using appropriate sterile technique, gowns, gloves, mask and cap, the patient was positioned properly. The right internal juglar vein was easily entered using the sonosite ultrasound. A wire was passed through the needle and into position. The needle was removed. The wire could not be advanced all the way through the SVC and met persistent obstruction at approximately 9 cm from the skin. A small incision was made and a dilator passed over the wire. A triple lumen central venous line was then passed over the wire through the IJ. It was advanced to 9cm and, at that point, could not be adbvanced further. The wire was then removed.Again, attempts were made without success in advancing the triple lumen cath any further than 9cm at the skin.There was good blood return from all ports. The cath was easily flushed with saline. The cath was then secured in place at several sites. The vasopressors were instilled through the distal port and instructions given to maintain vasopressors visa distal pot only.

Thanks!:)
 

DLS5697

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36556 with 77001-26 sounds like the codes you need, send me your fax # I will send you a Tool for catheters it has made my life so much easier.

Denise Sullivan,CPC
General & Specialty Surgery
417-820-3568
 

Trendale

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reply

Hi thanks for the info!
My fax number is 407-834-5011
Also waht Dx should I use?
Thanks!:)
 

dmgomez

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Would you fax me a copy too? My fax is 432-335-2486. Anything to make those easier would be nice. Thanks

Donna Gomez, CPC
Texas Tech University Health Science Center
 

Mklaubauf

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Hi Denise,
Would you mind if you fax me that tool also. My fax # 920-746-1072. Thank you so much

Also, may I ask you a separate question
When your physicians remove a perforated appendix and have to remove some of the cecum as well, do you code both 44960 & 44160? They do not bump up against each other in CCI edits.
Thank you again,
Marci Klaubauf, CPC
 

ksb0211

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I would love a copy of that, too! LOL
Fax: (386) 738-9537

I do have a question, though. Why would we use 77001-26 and not 76937-26 if it was ultrasound guidance?
Thanks.
~Kelly
 

lisammy

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I hate to disagree with you but there should not be any S&I billed with this procedure. 77001 is Fluro guidance for central venous access. This op note states ultrasound guidance. You can not use 76937 because it specifies that you need to have a permanant record and documentation on the findings.
 

alexandasia

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I would love that list too, but can I just request you posting it on here so you don't have to fax it to a ton of people?! If you prefer faxing it then my number is 623-399-8675. Thanks a bunch :)
 
Messages
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Nashville
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Hi Denise,
Would you mind if you fax me that tool also. My fax # 920-746-1072. Thank you so much

Also, may I ask you a separate question
When your physicians remove a perforated appendix and have to remove some of the cecum as well, do you code both 44960 & 44160? They do not bump up against each other in CCI edits.
Thank you again,
Marci Klaubauf, CPC
No you would not code for both. I would have to read the op note. If part of the terminal ileum was removed, then you would use 44160. If not, then you would use 44160. However, this code states partial colectomy with anastomosis and if one was not done (as with the procedure you suggest) you may have to use a 52 modifier. Might just be easier to code for the appendectomy with a 22 modifier. Thoughts anyone?
 

cwpierce

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Your report makes mention of ultrasound (76937) being used rather than flouroscopy (77001) so the use of 77001 -26 does not apply here unless flouroscopy was used. Your ultrasound (76937) cannot be billed here either as your report makes no mention that they were looking at "Vein patency". Unless they mention vein patency and have documentation for support, ultrasound is not included.

Your Dx for hypotension would be 458.9.

You determine tunneled vs. non-tunneled by the wording in the report. The physician usually makes mention in their report that they ran the leads through a tunnel. You will see this type of thing where they will run them to a port.

Your report above would code out as 36556 and 458.9.

Hope this helps.
Casey
 

midnightsun1369

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wondering why code 77001 (fluoroscopic guidance) would be used instead of 76937 (US guidance)? 77001 states fluoroscopic guidance, the note only refers to sonosite ultrasound. ????
 
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