Anesthesia Coding Alert

Narrow down by type of line, pump usage, and patient age.

Line placements are included in the services that anesthesia providers can code – and receive reimbursement for – in addition to responsibilities included in the standard anesthesia service. There are multiple questions to ask yourself when choosing the most appropriate code for these situations, beginning with which type of catheter was inserted.

Read on for ins and outs of coding for a peripherally inserted central venous catheter (also known as a PICC line).

Step 1: Verify Line Placement and Technique

A PICC line is a type of central catheter (long soft tube) that accesses the central venous system via a peripheral vein. The provider inserts the PICC line into a peripheral vein in the arm and it terminates in a central vein near the heart. You might also find a PICC line referred to as a “percutaneous indwelling central catheter.”

Important: You should have documentation that the tip of the catheter ends in the superior or inferior vena cava, the right atrium, or the subclavian, brachiocephalic (innominate), or iliac veins. If that’s not the case, you’re not dealing with a PICC line even if it’s peripherally inserted.

Also check whether the op note mentions that the catheter is “tunneled”— a technique in which the physician places a long catheter under the skin between the vein entry and external access sites.

“PICCs are not tunneled, so if you see documentation of a ‘tunneled PICC,’ this generally refers to placement of a catheter in a central vein like the internal jugular. For coding purposes, that would be considered a tunneled central venous catheter, according to the Society of Interventional Radiology (SIR),” says Robin Peterson, CPC, CPMA, manager of professional coding for Pinnacle Integrated Coding Solutions, LLC, in Hot Springs, Arizona.

If documentation shows that the catheter was tunneled, you’re probably coding for the anesthesia associated with the service rather than the catheter placement.

“The surgeon often tunnels the catheter and we provide anesthesia when necessary,” says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. “In that case, the anesthesia crosswalk code will depend on whether the surgeon performed a placement or repair. You may also have noticed the Professional Edition of the CPT^® book has a Central Venous Access Procedures Table, that provides a quick way to choose the surgical code for crosswalking to the anesthesia service (see page 274 in the 2020 CPT^® code book and page 304 in the 2021 CPT^® code book).”

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).

Step 2: Determine the Exact Service

Once you’ve established that your case is a PICC line, you can break down your code search based on which of the following services the surgeon provides:

• Insertion: For placing a PICC line, turn to one of the codes in range 36568-36571 (Insertion of peripherally inserted central venous …).
• Repair: The repair codes describe services for PICC or central venous catheter (CVC) lines, and are 36575-36576 (Repair of … central venous access catheter … central or peripheral insertion site).
• Replacement: For replacement of only the catheter, use 36578 (Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site). For complete replacement, use 36584 or 36585 (Replacement, complete, of a peripherally inserted central venous …).

Although CPT^® provides two codes for removal of central venous access devices (36589 and 36590), you shouldn’t use those codes for a PICC line.

Here’s why: The removal codes describe “Removal of tunneled central venous catheter…,” and a note following the codes states, “Do not report 36589 or 36590 for removal of non-tunneled central venous catheters.” Since PICC lines aren’t tunneled, these codes don’t apply to PICC line removal.

It doesn’t take much searching to realize that CPT^® doesn’t provide a removal code for PICC lines.

“PICC lines are intended to be more short term than a central line, so removal is included as part of a procedure follow-up visit or as part of an E/M service performed on that date,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, California.

Step 3: Check for Pump or Port

• Each group of codes for PICC line insertion, repair, or replacement separates codes by whether the service includes a pump or port. For example:
• Codes 36568-36573 describe insertions without subcutaneous port or pump, while 36570 and 36571 describe insertions with a subcutaneous port.
• Code 36575 describes repair without a subcutaneous port or pump, while 36576 describes repair procedures that involve a subcutaneous port or pump.

For complete replacement, code 36584 describes the procedure without a subcutaneous port or pump, while 36585 describes the procedure involving a subcutaneous port or pump.

Use partial replacement code 36578 (Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site) only for cases that involve a subcutaneous port or pump, which the code descriptor lists. Report a PICC line catheter-only replacement without a port or pump as part of a procedure follow up or E/M visit.

Step 4: Narrow Down Based on Patient Age

The two groups of codes for PICC insertion without a port or pump are 36568-36569 without imaging guidance and 36572-36573 with imaging guidance.

CPT^® divides most of the catheter insertion codes into “under 5” and “age 5 years or older” categories. Combine that information with whether a port is involved, and your choices break down as:

Age 5 years or older:

• ^{36569 — without port or guidance}
• ^{36573 — without port, with guidance}
• ^{36571 — with port}

Younger than 5 years of age:

• 36568 — without port or guidance
• 36572 — without port, with guidance
• 36570 — with port