IR Tunneled HD cath inserted in greater saphenous vein

ens555

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Hello, CPT 36569 seems to be the code for tunneled PICC inserted in greater saphenous vein - for dialysis access. Greater saphenous vein is considered peripheral insertion so it must be PICC, right? I do not see any codes for tunneled PICC w/o ports. I have not coded this scenario previously & it is not making much sense to me. Pt age is 60. Thank you
 

Jim Pawloski

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Picc lines are usually 5 to 6 french catheters and used for infusion procedures. You are looking a a 14 french catheter. What vein being used really doesn't matter, your looking at a tunneled CV catheter. Also PICC is a peripheral inserted central catheter and the only tunneled Picc is with a port.
HTH,
Jim Pawloski, CIRCC
 

thomas7331

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Picc lines are usually 5 to 6 french catheters and used for infusion procedures. You are looking a a 14 french catheter. What vein being used really doesn't matter, your looking at a tunneled CV catheter. Also PICC is a peripheral inserted central catheter and the only tunneled Picc is with a port.
HTH,
Jim Pawloski, CIRCC
Per CPT guidance, though, if it is inserted in the saphenous vein then it is considered peripherally inserted. Although I'd agree that this is not what is usually called a PICC line, it would still be coded with 36569 (or 36573 if done with imaging) because there is no separate code to distinguish between a tunneled or non-tunneled peripherally inserted CV catheter. Would you agree?
 

Jim Pawloski

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Where is the access, if it's at the groin, they went into the saphenous vein, to the common femoral vein and up so the catheter it should be in the inferior vena cava, so that is a central line. It's coded 36558.
Jim Pawloski, R.T. (CV), CIRCC
 

marandee

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Picc lines are usually 5 to 6 french catheters and used for infusion procedures. You are looking a a 14 french catheter. What vein being used really doesn't matter, your looking at a tunneled CV catheter. Also PICC is a peripheral inserted central catheter and the only tunneled Picc is with a port.
HTH,
Jim Pawloski, CIRCC
Hello Jim. I am seeking additional info regarding PICC lines, tunneled vs. non-tunneled. I was considering a PICC basilic inserted to Subclavian as tunneled (to subclavian), but without port (used short term for anti-fungal). What determines non-tunneled? and why PICC considered midline in some documentation? is this an error? - I realize original response was 2020, hoping you can respond.
Thanks,
Marandee
 

Jim Pawloski

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First, there is not a tunneled PICC line. Peripherally Inserted Central Catheter is a catheter inserted in the arm and ends in the Right Atrium. The only Picc that is a tunneled catheter is when it's with a port. Now there is a 4 or 5 french catheter that has a cuff on it so it could be tunneled from the anterior chest subcutanous to the jugular vein enters the vein and the tip of the catheter is at the atrium. But that is still a tunneled CVC and is coded 36558. When a PICC is inserted into the arm, but can only be inserted up to the axillary vein but no further because of obstruction, then you code 36569-52 (-74 for the hospital) to show that the intent was to place a PICC.

HTH,
Jim Pawloski, CIRCC
 
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