Anesthesia Coding Alert

Hint: Swan-Ganz usually overrides other special line placements.

Most line placements are included in the scope of service represented by anesthesia CPT^® codes. A few exceptions exist, however, which means you can report certain procedures as stand-alone services in many (if not most) instances. One of those services is the placement of Swan-Ganz catheters (93503, Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes).

Brush up on your Swan-Ganz savviness with these Q&As from Anesthesia Coding Alert subscribers, answered by says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

Question 1: Considering Swan-Ganz with Central Lines

Our anesthesiologist recently documented that we should code for a central line, arterial line, and Swan-Ganz catheter during a procedure. It’s been a long time since one of our physicians marked all three types of lines for a single case; what’s the current rule regarding line coding?

Answer: Begin by reporting the arterial line with 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous). When your physician uses both a central line and Swan-Ganz, the central line placement (36556, Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) is included in the Swan-Ganz fee. That means you won’t normally code for both placements.

Exception: You can report both the central line and Swan-Ganz if your anesthesiologist documents separate locations and placements for the central line and Swan-Ganz catheter. If you have clear documentation supporting the separate sites, append modifier 59 (Distinct procedural service) to 36556. Otherwise, you’ll only report 36620 and 93503 for the encounter you described. 

Question 2: Swan-Ganz Shares an Access Point

A provider placed an introducer into the patient’s central vein for central line access. Later, the same provider floated a Swan-Ganz catheter through the introducer. Can we code for the Swan-Ganz?

Answer: According to anesthesia coding guidelines, Swan-Ganz and central line placement through the same access site are inclusive. As indicated in the previous scenario, you can report both codes (93505 and 36556) if the line placements are at different sites.  

Also important: You should not report 93503 in conjunction with other diagnostic cardiac catheterization codes, according to the CPT^® guidelines. Instead, you should use 93503 “for placement of a flow directed catheter (e.g., Swan-Ganz) performed for hemodynamic monitoring purposes not in conjunction with other catheterization services,” per the guidelines.

Question 3: Line Placement with Guidance

Some of our doctors think they can code for ultrasound guidance with line placement. Is there a code to represent ultrasound guidance during 36620 and placements such as CVP and Swan-Ganz?

Answer: Yes, you can report add on code +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) along with line placement codes 36556, 93503, or 36620. Be sure to include modifier 26 (Professional component) for proper reimbursement.