Anesthesia Coding Alert

Drill down to the details for easy code selection.

When you code central venous catheter placement service by your provider, you turn to surgical codes in CPT^® rather than anesthesia codes. You’ll find numerous choices differentiated by several layers of details — which means you need to pay close attention in order to select the most appropriate code. Narrow your options by asking these five questions to ensure accurate selection.

1. Is the Line Central or Peripheral?

The terms “central” and “peripheral” are one key to your coding success.

The difference: A centrally-inserted line usually enters the patient’s jugular, subclavian, or femoral vein. A peripherally-inserted device (also sometimes called a PICC line) access the central venous system through a peripheral vein. You might see these placements referred to as CVA (central venous access) or peripheral access.

Central line choices include:

• 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age)
• 36556 (… age 5 years or older)
• 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age)
• 36558 (… age 5 years or older)
• 36560 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age)
• 36561 (… age 5 years or older)
• 36563 (Insertion of tunneled centrally inserted central venous access device with subcutaneous pump)
• 36565 (… without subcutaneous port or pump (eg, Tesio type catheter))
• 36566 (Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s))

Your list of choices for a peripheral insertion is considerably shorter:

• 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
• 36569 (… age 5 years or older)
• 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age)
• 36573 (… age 5 years or older)

Pro tip: Using CVA lines allows the anesthesiologist to directly administer medications into central circulation for the best effect. Anesthesiologists tend to insert temporary CVP lines to use for monitoring during the surgical case.

2. Did the Anesthesiologist Tunnel the Line?

Once you verify central or peripheral, look for whether the anesthesiologist tunneled the catheter under the skin (meaning he placed a long catheter under the skin between the vein entry and external access sites) or left the catheter exposed (non-tunneled).

Advantage: Tunneling a catheter offers better protection against 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, 36572, and 36573.

Take note: You’ll code differently if the surgeon tunnels the catheter and your provider handles anesthesia for the tunneling.

“The surgeon often tunnels the catheter, and we provide anesthesia when necessary,” explains Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “In that case, the anesthesia crosswalk code will depend on whether the surgeon completed a placement or repair.”

For catheter placement, report anesthesia code 00532 (Anesthesia for access to central venous circulation). For repair, select 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified).

Code 00532 is assigned a base unit value of four and code 00400 is assigned a base unit value of three.

3. How Many Lines Were Inserted?

Anesthesia providers usually insert a single catheter with a tunneled CVA (central venous access) device. There are times, however, when the situation requires two catheters with two different access sites (also known as a Tesio catheter). In that case, you have two code choices: 36565 and 36566.

Note: When an anesthesiologist places two lines it’s usually because he is increasing access, not because the multiple catheters are required. When you see two lines documented in your anesthesiologist’s notes, verify whether they were used for better access during the procedure or whether they were required so you can code correctly.

4. How Old Is the Patient?

CPT^® distinguishes most of the CVA codes by the patient’s age: as “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: One venous access code, 36563 (Insertion of tunneled centrally inserted central venous access device with subcutaneous pump) does not designate the patient’s age.

“That means you should not rule out reporting 36563 based on the patient’s age,” Dennis explains. “Code 36563 is the only CPT^® code for those circumstances, so you report it when it applies to the situation no matter the patient’s age.”

Example: The physician inserts a tunneled CVA device with a single access site into the jugular vein of a 4-year-old patient. Because the device has one access point, you can rule out a Tesio-type catheter (36565, 36566). You’ll eliminate other possibilities because the patient is under age 5 and because you’re reporting a centrally inserted device. This leaves you to select from codes 36555, 36557, 36560 and 36563. The tunneled catheter further narrows your code choices to 36557 and 36563.

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: A review of the documentation shows that the access device does not include a subcutaneous port or pump. Therefore, the appropriate code in this case is 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age).