# Picc line - Can we code the below



## prabha (Aug 26, 2009)

Can we code the below procedure with
   36569
   36000-5950
   76937-26
   75822-26.

After obtaining informed, written consent the patient was placed
      in the supine position and the right arm region was prepped and
      draped in the usual sterile fashion.

      After the administration of local anesthesia and under ultrasound
      guidance, a brachial vein was then accessed several cm above the
      elbow using a 21 gauge micropuncture needle.  An 018 inch
      guidewire was advanced through the needle and into the vein but
      multiple attempts to advance a wire centrally were unsuccessful.
      The needle was exchanged for a 5.5 French sheath.  A gentle
      injection of contrast and performed which demonstrated narrowing
      and tortuosity of the brachial vein.  Multiple attempts to advance
      and 018 Glidewire beyond the tortuous vein and into the central
      veins of the chest were unsuccessful.  The sheath was removed and
      hemostasis obtained with direct manual compression.  A sterile
      dressing was applied over the skin entry site.     

      The left arm region was then prepped and draped in the usual
      sterile fashion.

      After the administration of local anesthesia and under ultrasound
      guidance, a brachial vein was accessed several centimeters above
      the elbow using a 21-gauge micropuncture needle.  An 018 inch
      guidewire was advanced through the needle and into the vein and
      advanced centrally.  The needle was removed and exchanged for a
      5.5 French peel-away sheath.  A 5 French single lumen Power PICC
      line was cut to 41 cm in length and advanced through the peel-away
      sheath but failed to advance beyond the humeral head.  The PICC
      line was pulled back and a gentle injection of contrast was
      performed.  This demonstrated occlusion of the central brachial
      veins with filling of collateral vessels which appeared to empty
      into the central basilic vein/axillary vein.  An area of
      extravasation just central to the skin entry site was identified.

      The wire and peel-away sheath were removed.  Hemostasis was
      obtained with direct manual compression.

      After the administration of local anesthesia and under ultrasound
      guidance, the basilic vein was accessed several centimeters above
      the elbow using 21-gauge micropuncture needle.  An 018 inch
      guidewire was advanced through the needle and advanced centrally.
      The needle was removed and exchanged for a 5.5-French peel-away
      sheath.  A 5-French single lumen power PICC line was cut to 39 cm
      in length, advanced through the peel-away sheath and positioned at
      the atrial caval junction.  The peel away sheath was then removed.

      Post procedure imaging of the chest was performed demonstrating
      the distal catheter tip overlying at the atrial caval junction in
      good position.

      Impression:      
      Successful placement of a 5 French single lumen Power PICC line
      via the left basilic vein as described above.

      Narrowing and tortuosity of the right brachial vein with
      unsuccessful attempt to advance an 018 wire centrally into the
      draining veins of the chest as described above.

      Occlusion of the central left brachial veins with filling of
      multiple collateral veins which empty into the central basilic
      vein/axillary vein as described above.


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## Jim Pawloski (Aug 26, 2009)

prabha said:


> Can we code the below procedure with
> 36569
> 36000-5950
> 76937-26
> ...



You have 36005-50 for extremity needle, 75822 for bilateral extremity venogram, and 36569 for picc placement, 77001 for fluoroscopic placement.  Since they do not state that a hard copy image was taken with the U/S and you need documentation for the U/S, you cannot charge 76937.

Thanks, Jim


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## dpeoples (Aug 26, 2009)

Jim Pawloski said:


> You have 36005-50 for extremity needle, 75822 for bilateral extremity venogram, and 36569 for picc placement, 77001 for fluoroscopic placement.  Since they do not state that a hard copy image was taken with the U/S and you need documentation for the U/S, you cannot charge 76937.
> 
> Thanks, Jim



I agree completely. But you will probably need modifier 59 on 36005/75822.

HTH


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