Anesthesia Coding Alert

Studying Their Purposes Makes A-line, CVP and PA Cath Coding Easier

You can usually code invasive line placement and monitoring separate from the procedure's anesthesia, but do you know much about which lines are used for particular procedures? Read on to learn more about the purposes of different types of lines and how to code them correctly when your anesthesiologist places them.

Physicians use arterial lines (commonly called A-lines) to measure the patient's blood pressure and to provide easier access for drawing blood to study the gases present. This helps evaluate how well the lungs are working by how well they move oxygen into the bloodstream and remove carbon dioxide, says Debbie Gulledge, CPC, a coder with Anesthesia Associates of Rock Hill in Charlotte, N.C. The line also provides a reliable method to frequently check arterial blood samples so the anesthesiologist can respond appropriately.

Rationale: Unstable patients who are having surgery because of trauma often need A-lines. So do patients undergoing cardiac, vascular, chest, spine or brain surgery, because they are subject to rapid blood pressure changes, according to the American Society of Anesthesiologists' (ASA) statement on invasive monitoring procedures.

Report: The primary code for A-line placement is 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous). Code 36625 (... cutdown) also applies to A-line placement, but most anesthesia coders rarely report it because anesthesiologists normally use the percutaneous approach instead of cutdown. On the rare occasions that require cutdown placement because the anesthesiologist is unable to locate the patient's artery through the skin, the physician creates an incision and inserts the catheter under direct vision. The anesthesiologist might not have credentials to perform this open procedure, so the surgeon performs and codes for it instead.

Reimbursement: Coders rarely have problems gaining separate reimbursement for any arterial lines they do report, provided the physician clearly documents their placement. Expect to receive payment for 3 base units for 36620, or 5 base units in the rare instance of reporting 36625.

The group you code for might help determine whether you report the time associated with placing the A-line. Some groups bill it as a flat-fee surgical service with no time associated with it. Other groups, however, might charge for time depending on the circumstances, says Barbara Johnson, CPC, MPC, president of Real Code, Inc., in Moreno Valley, Calif. "If the physician places the line prior to anesthesia induction, you should not report time," she says. "But if the physician places it after induction, our office policy is to report the time."

Solution: When you report arterial lines, some carriers require you to append modifier -59 (Distinct procedural service) to separate the line placement from the procedure's anesthesia service. Other carriers consider A-lines to be modifier exempt, so verify which way you should report them.

The anesthesiologist monitors central venous pressure by inserting a central venous pressure (or CVP) line into the patient's superior vena cava. He also uses the line to monitor -- and possibly adjust -- blood volume or for central drug infusion during procedures that usually include fluid shifts (such as to assure adequate hydration for the transplanted kidney during a renal transplant case).

Many abdominal, cardiothoracic or other extensive vascular cases generally include CVPline placement to allow the anesthesiologist to directly administer medications into central circulation.

More Helpful: Previous versions of CPT only listed two CVP codes, but CPT 2004 changed that with its overhaul of all line placement and removal codes. Now several codes apply to CVP lines, based on the type of device, the patient's age and the placement technique: