Anesthesia Coding Alert

Hint: Location always matters.

In most of the cases you code, all the services provided by your anesthesia team member are included in the fee associated with the anesthesia code – but do you know a few exceptions exist? One of these potential exceptions is placement of a Swan-Ganz catheter. By remembering the ins and outs of Swan-Ganz coding, you can help ensure your provider gets additional reimbursement for the service when warranted.

Understand Why a Swan-Ganz Is Used

A Swan-Ganz catheter, or SGC, is designed for specific monitoring and central access purposes. You should report the placement with 93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes).

The anesthesia provider can use SGC to monitor pulmonary artery pressure while measuring cardiac output and other cardiovascular functions. The catheter has multiple ports for central circulation access, including a regional anesthesia (RA) port, PA port, central venous pressure (CVP) port, and possibly a main line or “introducer.”

Watch the names: A Swan-Ganz catheter also is known as a pulmonary artery catheter (PAC), says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. If your provider documents placement of a PA catheter that you believe is reportable, you’ll submit 93503.

Look for Additional Lines

You can report arterial lines in addition to Swan-Ganz lines, provided you have supporting documentation. When you do, report the arterial line with 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous).

However: Seeing documentation of other lines being placed in addition to the Swan-Ganz doesn’t automatically mean you can report each line separately. Pay attention to the details to verify what you can legitimately code.

When an anesthesiologist places a Swan-Ganz catheter, he runs (or threads) it through the CVP line. National Correct Coding Initiative (NCCI) edits list the CVP line as part of the Swan-Ganz. Because of this, you normally report only the Swan-Ganz placement with 93503 instead of coding for both lines.

Exception: You can report both the CVP and the Swan-Ganz if your provider documents separate locations and separate line placements for the central line and Swan-Ganz catheter. Append modifier 59 (Distinct procedural service) to the central line code, 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age) or 36556 (… age 5 years or older).

Be alert for this situation when you code heart cases, because there can be many instances where the anesthesiologist will use both a CVP line and a Swan-Ganz catheter. For example, the anesthesiologist might place a Swan-Ganz line in order to monitor cardiac output, and place a CVP line separately because of the need for multiple central vein IV access.

If the insertion sites are different, this is an obvious indication that the CVP was separate from the SGC, so you can report both line placements.

Extra tip: It’s not uncommon for a physician to use a chest X-ray to confirm accurate Swan-Ganz catheter placement. Do not include a code such as 71045 (Radiologic examination, chest; single view) on the claim, even if the anesthesiologist clearly documents the service. NCCI edits bundle the two services and do not allow you to override the edit to report both placements.

Support the Service with Diagnoses

Your provider’s documentation should include the specific reason why Swan-Ganz monitoring is necessary. Review the patient’s chart and medical history for potential diagnoses that would support medical necessity.

Examples of supporting diagnoses can include: