# Questions about CVC Catheter Insertion



## preserene (Nov 11, 2010)

Questions about CVC catheter Insertion
I am totally confused (you can understand from the way my questions go!)
My mind is  very refractory to understand;
Q1)  Am I right to presume that tunneled means – with subcutaneous  port / pump; non tunneled means without those. If not, how am I to know it correctly in an easy fast track?
Q2) How are we to differentiate non tunneled centrally inserted from non tunneled peripherally inserted site(entry site)
Q3). The CPT manual says: “CENTRALLY INSERTED CVC venous entry sites are- Jugular vien, Subclavian Vein, Femoral vein.  The PERIPHERALLY INSERTED CVC venous sites ARE- Basilic vein, Cephalic vein”. 
Can they be either way? Or, are they so selective?
If they are not so selective that way, then, how are we to select the code from peripheral from central?, when the description does not provide that?
Non tunneled from tunneled?, when neither of these descriptive terms are posted in the OP NOTES? (You know the description in the OP Notes are often not the way they are in CPT )
 For eg,  femoral vein is selected for.  Is it central insertion site or peripheral insertion site or either of them; can it be tunneled or non tunneled. As per the CPT guide, it is central insertion site for CVC(36556).  If I select a code for peripheral (36569),  am I wrong?
I need to understand in a lightning speed not so refractory the way I stand now. 

Anyone who could simplify  the whole lot , I would really appreciate and thank you in advance
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## Jim Pawloski (Nov 12, 2010)

preserene said:


> Questions about CVC catheter Insertion
> I am totally confused (you can understand from the way my questions go!)
> My mind is  very refractory to understand;
> Q1)  Am I right to presume that tunneled means – with subcutaneous  port / pump; non tunneled means without those. If not, how am I to know it correctly in an easy fast track?
> ...



Let me try the Readers Digest version:
1.Tunneled catheters (do not have to have ports)- Mediport insertion and Permacaths. Catheter is tunneled under skin
Non tunneled catheters - Quinton type dialysis catheters usually jugular inserted or femoral inserted.
2. Picc lines (Peripherally inserted central lines.  Usually entered in the arm (brachial, basiliac, or cephalic vein), centrally inserted, jugular or femoral inserted.

HTH,
Jim Pawloski, CIRCC


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## preserene (Nov 12, 2010)

Thank you very much, Jim 

 So PICC lines will not be inserted into Jug, femoral  etc. Can PICC be inserted into the  other peripheral lines like saphenous , popliteal, peroneal, Brachial Cubital too?
So when the op note shows there was femoral entry point, it goes without doubt, it is central insertion, right?
Then when it is documented PICC , it goes only for non tunneled ; or is there a provision  /practice  for tunneled too.
We do not have code sets for tunneled or non tunneled  PICC. What I assume is that there is no necessity for tunneling  stuff in peripheral because it is already very superfial and easy access. Does that make sense. I just clear my doubt .That is it.
Thank you very much for clearing my doubts Jim


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