Anesthesia Coding Alert

Check 3 factors to ensure your billing is correct.

Anesthesia providers often place lines for patients, whether it's in conjunction with surgery or for other reasons. The next time you code for a PICC (percutaneously inserted central catheter) line insertion, consider three important factors to ensure you choose correctly.

Note the Patient's Age

CPT^® divides most codes for line insertion/venous access by age. Look at descriptors for terms such as "under 5" and "age 5 years or older" to automatically narrow your choices, advises Leslie Johnson, CCS-P, CPC, manager of coding, compliance, and education for Somnia, Inc., in New Rochelle, N.Y. This structure holds true for your PICC line options:

• 36568 -- Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age
• 36569 -- ... age 5 years and older.

Verify Who Inserted the Line

"It's fairly common for non-physicians, such as nurses, to insert PICC lines," says Leesa A. Israel, BA, CPC, CUC, CMBS, executive editor with The Coding Institute.

Remember: You cannot bill for PICC line insertions by non-physicians in the facility setting -- but a CRNA (certified registered nurse anesthetist) is outside the "non-physician" category of registered nurses and physician assistants. If a CRNA or anesthesiologist places the PICC, you can report the service; if an RN or PA inserts the line, however, you can't bill the service.

Flat fee: "The insertion of arterial lines and PICC lines are outside of the normal anesthesia services," Johnson says. "There aren't any time or base units associated with these procedures because they're considered to be surgical procedures instead of anesthesia/monitoring."

Reimbursement will vary according to your local conversion factor. The national Medicare facility fee for 36569 is $92.24, based on the national CF of $34.0376. The national Medicare facility fee for 36568 is slightly higher at $96.33, since the patient is a young child.

Determine Whether the Provider Used Guidance

"Blind" sticks were the norm for years, but more providers use ultrasound guidance for PICC line placements today. If your provider uses ultrasound guidance, report +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real time ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]).

Tip: If your anesthesia practitioner doesn't own the equipment or if he performs the procedure in a hospital, don't forget to append modifier 26 (Professional component) to 76937. "Otherwise, you may face denials, especially from Medicare," Johnson says.