Anesthesia Coding Alert

Question: I see on the anesthesia records under “central line” that my provider put “Right IJ double lumen.” I’m new to anesthesia coding so am not sure if that’s enough to report 93503. Or, does it support 36556 (since someone told me to look for CVP codes)? What documentation do I need in order to bill for Swan-Ganz?

New Jersey Subscriber

Answer: Any lines that the anesthesiologist or CRNA place must be documented in the anesthesia record before you can code separately for them. The note should clearly state who placed the lines; if they were placed by anyone other than an anesthesiologist, CRNA, or SRNA, they are not billable for anesthesia. If an SRNA places the line, the teaching physician or CRNA must document their involvement since SRNAs don’t have provider numbers to report these “surgical” services.

If you’re reporting a Swan-Ganz catheter, submit 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) as you mentioned. Code 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) can apply for central venous line placement, but you’ll need to verify that the documentation supports this code rather than one of the others from that family.

When documenting with a manual record, your providers should check which lines were placed and where they were placed anatomically. On an electronic record, they should document for each one separately. This is the same as for nerve blocks used for post-op pain relief.

Also remember: Sometimes the anesthesia provider uses a CVP to thread a Swan-Ganz. When this happens, the documentation should make it clear to the coder so that you’ll know to report only 93503 for the Swan-Ganz instead of 36556 or both codes. The exception to this is if the provider clearly documents a need for the two separate lines.