# correct coding for midline catheter



## Rita Bartholomew

I'm getting differing opinions on how to code a midline catheter insertion.  Some say 36569 is okay.  Dr. Z seems to indicate that it is only okay if the intent was to place a PICC, but an obstruction was encountered (ant then modifier 52 would be appended).  Others are saying they always use 36569 when coding a midline insertion.  Some say 36000 is more appropriate.  I'm not sure which way to go.  Any thoughts?


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## dpeoples

Rita Bartholomew said:


> I'm getting differing opinions on how to code a midline catheter insertion.  Some say 36569 is okay.  Dr. Z seems to indicate that it is only okay if the intent was to place a PICC, but an obstruction was encountered (ant then modifier 52 would be appended).  Others are saying they always use 36569 when coding a midline insertion.  Some say 36000 is more appropriate.  I'm not sure which way to go.  Any thoughts?



I don't think there is a "one size fits all" answer to this question. I think it all depends on the documentation. There is a subjective component to coding.

HTH


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## Rita Bartholomew

*what about this one?*

What is your opinion about coding the following midline.  36569-52 or 36000?

_BEDSIDE ULTRASOUND GUIDED RIGHT BASILIC MIDLINE:  The risks were explained and informed consent was obtained.  Ultrasound was performed of the arm identifying an adequately sized right basilic vein.  The arm was then prepped and draped in the standard fashion.  The vein was accessed in the standard fashion using the Seldinger technique and ultrasound guidance.  The Mid line was then placed based on measurements and estimated venous length.  The patient tolerated the procedure.

IMPRESSION:   A Mid line was placed using ultrasound guidance.  _


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## dpeoples

Rita Bartholomew said:


> What is your opinion about coding the following midline.  36569-52 or 36000?
> 
> _BEDSIDE ULTRASOUND GUIDED RIGHT BASILIC MIDLINE:  The risks were explained and informed consent was obtained.  Ultrasound was performed of the arm identifying an adequately sized right basilic vein.  The arm was then prepped and draped in the standard fashion.  The vein was accessed in the standard fashion using the Seldinger technique and ultrasound guidance.  The Mid line was then placed based on measurements and estimated venous length.  The patient tolerated the procedure.
> 
> IMPRESSION:   A Mid line was placed using ultrasound guidance.  _



I would code this 36569/76937. He does not say where the catheter tip is, the term "midline" is subjective, though certainly it is not in the RA. It could be in the SVC or at least the subclavian vein. The point is that there is not enough information, IMO, to reduce the procedure (mod 52). 

HTH


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## Rita Bartholomew

So, if there was documentation that the tip was not in a central vein, then 36569-52?


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## dpeoples

Rita Bartholomew said:


> So, if there was documentation that the tip was not in a central vein, then 36569-52?



I guess so, but the real question is "what is the defintion of a central vein"? The CPT defines central catheter as one that terminates in the Right Atrium, the Vena Cava, Iliac, Subclavian or Brachiocephalic vein. So, even though the access is the basilic vein, if the 
termination point is anywhere in the subclavian vein, you still have a PICC. Calling it a "midline" does not change the code. No reduction would be warranted.

HTH


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## romanogw2

Found this old topic and I have a question.

Is the kit and the line billable?  We are inserting midlines and Picc lines in a infectious diseases office for antibiotic infusion.  Also, does the 52 modifier reduce payment by Medicare?


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