# Hemodialysis catheter insertion CPT HELP !!



## bill2doc

Hemodialysis catheter insertion.

The patient developed acute kidney injury and life-threatening hyperkalemia.  The decision was made to proceed with hemodialysis.  Patient has a right intrajugular transvenous paper and neck was avoided at all costs as to not inadvertently displace the pacemaker.   The right femoral vein was targeted.  The area was cleaned and draped.  With ultrasound guidance, a dialysis catheter was inserted into the right femoral vein on the first attempt via the Seldinger technique and sutured with place.  The catheter was then flushed and catheter tips filled with heparin. There were no  complications.  

Can someone help with the correct CPT please. Thank you !


----------



## cblack712

36556 for non-tunneled placement. I will warn you though that there is room for improvement on this report. If the physician would dictate that patency of the vein was obtained and stored with use of ultrasound you could also use 76937. Without that statement the only billable code on the report is the 36556


----------



## bill2doc

Thank you cblack712.  The physician did a C-Line insertion, A Line insertion and the above mentioned Dialysis cath insertion.  Will I be able to bill for 2 36556 codes? (1 central line) (2 Dialysis cath) ?


----------



## cblack712

With appropriate documentation and either a 78 or 58 mod you should be able to - The insurance will likely require reports for both. Double check your central line placement though and make sure that there is no port and it is not tunneled, that will change the CPT codes


----------



## bill2doc

Central line insertion.

INTRODUCTION:  The patient required multiple pressor agents and IV drips in an inadequate IV access.  An additional central line was indicated.  With ultrasound guidance, the femoral vein was targeted.  On the first attempt, a triple-lumen catheter was inserted into the left femoral vein via the Seldinger technique and sutured in place.  The catheter was flushed and ready for use.


Arterial line insertion.

INTRODUCTION:  The patient was hypotensive on multiple pressor agents and precise hemodynamic monitoring was required.  The patient also required frequent arterial blood gas sampling and has poor peripheral radial arterial pulsation.  An arterial line was, therefore, indicated.  

DESCRIPTION OF PROCEDURE: Under ultrasound guidance, the left femoral artery was identified on the first attempt.  A femoral arterial catheter was inserted into the left femoral vein on the first attempt via the Seldinger technique.  This was attached to an arterial line apparatus where appropriate waveforms were identified.  The catheter was then sutured in place and dressing was applied.


----------



## cblack712

Yep. I would use the 78 mod on one of the 36556 since none appear to have the port or are tunneled and def work on getting the doc to verify patency of the selected vein so that you can code the 76937. You are loosing money without that statement being included in the reports.


----------



## bill2doc

Will do. Thank you so much!!!  I imagine 76937 would need a -26 if able to code.... Thank you again!


----------



## cblack712

Unless you own the equipment than yes, you would need the 26 modifier.


----------

