Anesthesia Coding Alert

Question: Can we bill separately for a CVP line and a Swan-Ganz catheter in the same heart case if each is used for a different purpose (i.e., if the Swan-Ganz is used for cardiac monitoring, and the CVP line is placed because of difficult IV access)?

Anonymous IN Subscriber

Answer: If two separate lines for the procedure are documented on the medical record, both may be billed and reimbursed. Use codes 93503 (insertion and placement of flow directed catheter for monitoring purposes,) and 36489*-59 (placement of central venous catheter, percutaneous, over age 2). The -59 modifier is used to identify procedures or services that are not normally reported together but are appropriate under the circumstances. If you use the -59 modifier for the second catheter, be sure the documentation clearly shows that two lines were inserted.

Guest expert: Bellinger Moody, compliance officer at Medac, an anesthesiology billing service in Augusta, GA.