Watch patient age, procedure description when identifying venous access devices. CPT® includes 13 codes for central venous catheter insertion (36555-36571), which gives you a wealth of choices to weed through. The next time your anesthesiologist inserts one of these lines during surgery, ask yourself five questions to narrow your options to the correct code. 1. How Many Access Points? In the (relatively uncommon) case when the physician inserts a tunneled CVA (central venous access) device requiring two catheters with two different access sites (also known as a Tesio catheter), you can narrow your code selection to just two codes: "Using two catheters is more common for dialysis," says Scott Groudine, MD, an anesthesiologist with Albany Medical Center in Albany, N.Y. "Anesthesiologists might sometimes place two lines, but the second line isn't 'required' as part of the placement " we just want lots of access." Result: 2. How Old Is the Patient? CPT® divides most of the CVA codes into "under 5" and "age 5 years or older" categories. Because of this, you can automatically eliminate almost half your code choices simply by knowing the patient's age. One exception: 3. Is It a Central or Peripheral Insertion? Now, check your documentation to see if the surgeon inserted the access device centrally or peripherally. To determine this, you must know exactly which vessel the venous access device accesses. A centrally inserted device usually enters the jugular, subclavian or femoral vein. A peripherally inserted device (often identified as a PICC line in surgeon documentation), in contrast, accesses the central venous system via a peripheral vein, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock. Central choices: Peripheral choices: 4. Is the Catheter Tunneled? Next, determine whether the anesthesiologist tunneled the catheter under the skin or left it exposed. Tunneling describes a technique in which the physician places a long catheter under the skin between the vein entry and external access sites. "In other words," Groudine says, "the external site where the catheter leaves the patient is several centimeters away from where the catheter enters the vein." Tunneling makes it more difficult for bacteria migrating along the catheter from the skin to reach the blood stream. Codes for tunneled catheters include 36557, 36558, 36560, 36561, 36563, 36565 and 36566. For non-tunneled catheters, your choices include 36555, 36556, 36568, 36569, 36570 and 36571. Example: Also note: 5. Is There a Pump and/or Port? The final step in deciding the correct CVA code is verifying whether the access device includes a subcutaneous port and/or pump for injecting and/or administering medication directly into the vein. Codes describing venous access devices without a pump or port include 36555, 36556, 36557, 36558, 36565 and 36568. For a venous access device with either a pump or port, your choices are 36570 and 36571. Codes 36560, 36561 and 36566 describe procedures with a port only, while 36563 describes a procedure with a pump only. Example: