# Subclavian Port-A-Cath Insertion question



## BABS37

Not sure of the correct code for this. I came up with 36556 (patient is 54) but do I need this to say 'tunneled or nontunneled'? 

Procedure: Left Subclavian Port-A-Cath insertion

Procedure:
The left chest wall was prepped and draped. Lidocaine was infiltrated and teh subclavian vein was then accessed with a single puncture. Guidewire was passed proximally under fluoroscopy. Incision was made under the wire insertion site and a pocket was created inferiorly with blunt dissection. Dilator and sheath were passed over the wire under fluoro. The wire and dilator were removed. Silastic catheter flushed and aspirated nicely. It was trimmed and attached to the pectoral fascia with 3-0 vicryl. The port was aspirated and flushed with heparinized saline. The wound was closed with inverted interrupted 3-0 vicryl and dermabond. The patient tolerated the procedure well. 

Most of these ports are pretty much the same verbiage and I'm not sure if I'm in the correct ball park for these or not. 

Any advice is much appreciated


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## BABS37

Can anyone help me? Is there more documentation that is needed? Am I somewhat in the right ball park? This is how every one of his reports looks...


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## lindacoder

I always look for "tunneled" when billing infusaport insertion.  Otherwise I think it would just be 36556.  The CPT code for infusaport is 36561 (over 5). I don't know if you have access to Coder's Desk Reference for  Procedures but it breaks it down as to the difference of the two procedures. If you can get it and then show the physician the difference it may make a difference. Hope that helps.


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## megha

i agree with linda and i think it is tunneled and i think it should be 36561. i wondering if we can use fluoroscopic guidance additional to this procedure, please look in to code 77002. i hope this help let me know thanks


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## BABS37

Yea, I asked my doctor if he could start clarifying for me 'tunneled' so it would lead me in the right direction but for now, this is all I have to go by. We just brought this doc on. I keep going back and forth between 36556 and 36561.

 What DX do I use for these when he doesn't tell me what the cancer is?


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## ASH527

you could try using dx v58.69 high risk medication


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## cblack712

A Port-A-Cath is a type of cath that falls under the category of CVAD (meaning that they are implanted or tunneled) since the doc is indicating that it is a "Port-A-Cath" then you would use 36561. The use of the Dilator and sheath being passed over the wire and then removed is the method used for tunneling. The doc may not be saying "tunneled" however he is describing tunneling. You would also code 77001 not 77002 as 77001 is specific to Central Venous Access procedures. Correct dx to use would be V58.81 since this is the fitting of a vascular cath. Don't assume that it is for cancer either - CVA's are placed for sepsis, chemo, infections - etc.


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## codedog

I Agree with cblack712, on CPT and ICD-9


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## pwright3603

I agree with clback712 as well.


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## BABS37

Thanks for the help everyone  I ended up calling my surgeon as I needed to get that coded and out the door. I went with 36561, 77001 (as I realized 77002 was incorrect to start with) and V58.81 so all is good.


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## bran1120

If you are coding the fluoro guidance then your physician has to be the one interpreting and dictating the radiology report.  You cannot bill the fluoro guidance if there is a radiologist interpreting the report separately.


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