# Tunnelled PICC



## SMARTSIVA (Aug 20, 2010)

Good Morning,

What would be the appropriate CPT code for Tunneled PICC placement? Is it correct to use 36568/36569 as per age criteria?

A patient was placed a 5 french single lumen powerline catheter with a subcutaneous cuff.

I really appreciate your valuable feedback.

Thanks,
Siva, CPC, CPC-H.


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## Terry L (Aug 29, 2010)

*Peripheral tnneld PICC*

Hi

Look at code 36571.


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## preserene (Aug 30, 2010)

Hi I was under the impression that PICC procedures have no code set for tunneled procedure, becaus eit is a totally diferent route ,meaning the port of entry itself is straight into peripheral vein.
I was under the impression that PICC is different from tunneled because the tunneled goes beneath the skin like a tunnel to reach its destiny of central venous system(via jugular vein); whereas the PICC is just select a periphral vein like cubital and reaches  its destiny.

So do you mean to say the 'Device'  at 3657x is a 'tunneled'.  I am confused why would you select 3657x for the tunneled 
 I am not aware of it.
Can any one throw some light on this.


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## Grintwig (Aug 31, 2010)

I would need to see more of the OP note to be comfortable attempting to code that.
Did the physician say it was a PICC line or are you calling it a PICC line? Did the physician say it was tunneled because in that statement I do not see tunneled? How old was the patient? Why was the device placed?


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## Shirleybala (Sep 2, 2010)

*Tunneled picc line placement*

Please find the report and suggest appropriate CPT.
   Clinical history:

      54-year-old male HIV positive with osteomyelitis, requiring
      long-term IV antibiotics. Request is made for a tunneled PICC
      placement.

      Procedure: Ultrasound and fluoroscopy guided tunneled PICC
      placement

      Informed consent was obtained after discussing risks, benefits and
      alternatives.  Risks discussed included but were not limited to
      bleeding, infection, venous thrombosis etc.

      Preliminary ultrasound was performed of the left arm demonstrating
      a patent basilic vein.  The left arm was prepped and draped in
      usual sterile manner and locally anesthetized with 1% lidocaine.
      Under real-time ultrasound guidance the left basilic vein was
      accessed with a micropuncture set.  A sonographic image was stored
      for the medical record.

      A 5-French single lumen Bard Powerline with *subcutaneous cuff was
      then tunneled to the puncture site. * The puncture site was dilated
      and a peel-away sheath placed.  The catheter was advanced through
      the peel-away sheath, positioned with the tip in the super vena
      cava.  The peel-away sheath was removed and hemostasis achieved
      with manual compression.  The catheter was sutured in place with
      Prolene and a sterile dressing applied.  No immediate
      complications.

      Impression:      
      Ultrasound and fluoroscopy guided *placement of a tunneled single
      lumen PICC line (Bard Powerline) via left basilic vein*.  Catheter length is 49 cm.


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## Grintwig (Sep 13, 2010)

OK one more question was there a subcutaneous port?
If I go by the OP note alone (which I always do) then this would be 36569 as there is no subcutaneous port mentioned.


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## Hari Prasadh (Sep 14, 2010)

this is a PICC line, though he is using word tunnelled, actually no work was done to creat a tunnel in the report. it would be 36569.

Harish, CCS, CPC


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