# IV start by CRNA



## katiejeanne (Apr 11, 2013)

I am needing some guidance...we had an inpatient who was a hard IV stick so they had our CRNA insert an IV, but in his note it seems more complicated than your usual IV insertion. Here is the main part of his procedure note:

The left arm was used for the arterial line kit from Arrow, indwelling catheter, 20-gauge, 5-inch.  The guidewire was floated through the existing 20-gauge catheter.  The 20-gauge IV, 1-inch catheter was then removed.  The site was re-prepped with Betadine and the 20-gauge, 5-inch catheter was placed atraumatically, and the guidewire was removed.

I feel like I should be able to charge for this. He marked 36410 on his charge sheet. Does this seem like the right code? I see an addition to this code in the CPT book this year stating "a physician or other health care professional" can charge this. Or is another code more appropriate? Any thoughts are welcomed!! Thanks all!

Katie, RHIT


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## bwolfe1 (Apr 11, 2013)

Check with the CRNA, but reads like he placed an Arterial Line. Code 36620.


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## Michele Hannon (Apr 12, 2013)

It would appear from your brief note that an arterial line was already in place and the CRNA placed a longer catheter (over a guidewire) in the same vessel. This actually requires less work. Would also suggest querying the provider. He/she should probably document the vessel and the reason the catheter needed changing.


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## katiejeanne (Apr 15, 2013)

Thank you for your feedback! He actually placed the IV (Sorry I didn't post that part of the note) then inserted the catheter to provide more of a "solid" IV since she was such a hard stick. The vessel was the AC vein. Thanks!!


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## katiejeanne (Apr 15, 2013)

Due to multiple attempts by the nursing staff, Anesthesia was consulted to see if we could establish an IV.

DESCRIPTION OF PROCEDURE:  The patient was identified.  The left antecubital area was cleaned with alcohol and then chlorhexidine in a sterile fashion.  A 20-gauge, 1-inch IV was then started in the left AC.  Prior to IV start, 1% lidocaine was used to infiltrate the area for patient comfort.  The IV was then secured in place by nursing staff.  A discussion was held with the admitting physician about the need for a more secure IV.  Therefore, it was decided to use the arterial line kit from Arrow, which includes a 5-inch, 20-gauge indwelling catheter, and utilize this over the guidewire in the left AC vein.  Therefore, the IV was re-prepped with Betadine and chlorhexidine in a sterile fashion.  Sterile gloves and mask were used.  The left arm was used for the arterial line kit from Arrow, indwelling catheter, 20-gauge, 5-inch.  The guidewire was floated through the existing 20-gauge catheter.  The 20-gauge IV, 1-inch catheter was then removed.  The site was re-prepped with Betadine and the 20-gauge, 5-inch catheter was placed atraumatically, and the guidewire was removed.  Aspiration for blood was positive with good flow.  The new IV was then capped per hospital policy.  The entire site was re-prepped with chlorhexidine and a sterile, occlusive dressing was applied.  Approximate blood loss was less than 1 cc.  The patient tolerated the procedure well.  Nursing staff was notified that this is a 5-inch indwelling catheter.


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## katiejeanne (Apr 23, 2013)

Any other thoughts on this? Can an arterial line cannulation be coded (36620) even though it was into a vein? This is the first one done by a CRNA for an IV start in our hospital so this is very new to me. Any help is appreciated!!
Thanks!
Katie, RHIT


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## dwaldman (Apr 23, 2013)

36410 mentions for  diagnostic or therapeutic purposes (not to be used for routine venipuncture) , but seems to be appropriate. 

December 2008 page 7

Surgery: Cardiovascular, 36000 (Q&A) 

Question: If blood is drawn from a vein using a butterfly catheter (for purposes of obtaining a laboratory specimen), would it be appropriate to report code 36415 or code 36000? 

Roger Hettinger, Sioux Falls, SD

Answer: Code 36415, Collection of venous blood by venipuncture, should be reported because it describes venipuncture to obtain a blood specimen using either a butterfly or another type of blood collection apparatus. It would not be appropriate to report code 36000, Introduction of needle or intracatheter, vein, because code 36000 involves not only placement of a needle or intracatheter into a vein but is specifically used when a venous injection procedure is being performed. If the venipuncture requires physician's skill, then a code from the 36400-36410 series may be appropriate. 

The collection of the specimen by venipuncture is not considered an integral part of the laboratory procedure performed. If both the collection of the specimen(s) by venipuncture and the laboratory procedure(s) are performed, then it would be appropriate to report a code for the collection of the specimen(s) in addition to the appropriate code(s) from the 80000 series for the laboratory procedure(s) performed.


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