Anesthesia Coding Alert

Hint: It’s all about the associated CVP line.

Most services your anesthesiologist provides are included in the anesthesia code fee, but a few are separately reportable. One of those possibilities is Swan-Ganz catheter placement with 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). The next time you’re considering whether you can submit 93503, keep these points in mind. 

Know its purpose: A Swan-Ganz catheter (SGC) is designed for specific monitoring and central access. Your provider can use SCG to monitor pulmonary artery pressure, plus measure cardiac output and other cardiovascular functions. The catheter has multiple ports for central circulation access, including a regional anesthesia (RA) port, PA port, CVP port, and possibly the main line or “introducer.” 

Know its alias: A Swan-Ganz catheter is also known as a pulmonary artery (PA) catheter, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. If your provider documents placement of a PA catheter that you believe is reportable, you’ll submit 93503. 

Know its setup: When an anesthesiologist places an SGC line, he runs (or threads) it through the central venous pressure (CVP) line. So when the CVP line is inserted as part of the procedure of inserting an SGC, the CVP line is considered a component of the line placement, and is not reimbursable. Only the Swan-Ganz line is reimbursable, unless you have clear documentation that the physician placed the lines during different encounters or at different sites. 

There are many instances where the physician will use both a CVP line and a Swan-Ganz catheter in the same heart case for different reasons.

Example: Your anesthesiologist places 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 two separate lines for the procedure are documented on the medical record, you can code both and expect separate reimbursement. Report 93503 and 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older). Since you need to show that the CVP line is separate, append modifier 59 (Distinct procedural service) to 36556. If the insertion sites are different, this is an obvious indication that the CVP was separate from the SGC.

Arterial line difference: Anesthesia providers usually can separately report arterial line placement, if you have supporting documentation. If your provider places an arterial line along with a Swan-Ganz, you can bill for both placements. Report the arterial line with 36620 (Arterial catheterization or cannulation for sampling, monitoring, or transfusion [separate procedure]; percutaneous). 

Resource: To learn more about successful line coding, read “Statement on Intravascular Catheterization Procedures” from the American Society of Anesthesiologists. Visit http://www.asahq.org and click on “Standards and Guidelines” under the “Resources” tab. A PDF of the statement can be found under the “Catheterization” category.