# Placement of Venous Access Device



## geugene (Apr 14, 2010)

Hell everyone.

Please help with the following report 36561 vs. 36558

*Procedure:* Place of venous access device using ultrasound, fluoroscopy, subcutaneous tunnel. *History:* The patient is a 27-yr. old male with sickle cell anemia. He is going to udergo apheresis. A double-lumen port was requested to faciliatate the administration. Risk explained.

*Procedure Details :* Patient was taken to the OR. Given adequate general endotracheal aesthesia. The right neck and chest were prepped with chlorhexidine and draped in a sterile and appropriate fashion. The patient had been given IV antibiotics. Time-out was performed as per protocol. The right IJ was found with ultrasound. The needle was placed in right IJ using ultrasound guidance. The guidewire was placed. Fluoroscopy was used to confirm good placement. A pocket was created on the right upper chest. The tunneling device connected the pocket to the venipuncture site. A double-lumen Vortex catheter was in place. I was brought up through the tunnel, placed through the tearaway sheath, positioned in the superior vena cava. It was then attached to the reservoir. The locking device was engaged appropriately. It was secured in the pocket with 2-0  Vicrly. It aspirated and flushed easily. The pocket was closed. The neck incision was closed. Sent to recovery. Chest x-ray show good placement.

TIA


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## Hopp (Apr 14, 2010)

Hi You might want to look at code 36566? and dont forget to
code for the the US guidance  77001 with 26TC
Deb, CPC


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## geugene (Apr 15, 2010)

Tks, I did remember to use the 77001 with 26 modifier. However, it was a tunneled device. I believed that 36561 was correct because of the port. However, another coder believes it 36558 because of the pocket.
Any advice?


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## acombspsa (May 13, 2010)

I agree with 36561. Also, the op note states both fluoroscopy and US guidance were used, so I would add both 77001-26 and 76937-26.


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## RCBBuell (May 14, 2010)

Hi,

We do these alot.  I would use the 36561 but we do not use the 76937 my doctors have alsways said that that is included in the procedure.  They would never do the procedure without.

Becky


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## Yvette1 (May 17, 2010)

We also do alot of these we would use the 36561 and 77001-26 we do not code the 76937-26.  Is anyone getting paid by coding all three? I have typed in an example on my code Correct and it did say you could use all three. There were no LCD's found. Corresponding procedure(s) for use of 76937 may include: 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36575, 36576, 36578, 36580, 36581, 36582, 36583, 36584, 36585.


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## MCook (May 18, 2010)

I was taught that when a pocket is created, it is code 36561.  We bill 77001-26 along with it for the fluoro.  Cath's always confused me until someone shared that nugget! Then 'pocket' became my favorite word!

Michelle


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## Cyndi113 (May 26, 2010)

Interesting! What if the MD places a venous sheath for venous access. There is no termination in the subclavian, brachiocephalic or iliac.


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## acombspsa (Jun 17, 2010)

We get paid for both 77001-26 and 76937-26. Our surgeons do not use it every time, and I have never been told that it is included in 36561.


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