Anesthesia Coding Alert

Question: How would we bill for placement of a central line and Swan-Ganz catheter for post-operative care following CABG procedures? The surgeons have asked our anesthe­siologist to place these. We are mainly concerned with how to bill the Medicare patients.

Washington Subscriber

Answer: There is no separate payment when the anesthesiologist places multiple lumens. You may bill for both the central line (CVP) and Swan Ganz if they are two separate lines used for different purposes. Before billing, verify that your provider documented both line placements and monitoring.

Explanation: When an anesthesiologist places an Swan-Ganz catheter, he runs it through the CVP line. Because of this, when the CVP line is inserted as part of the Swan-Ganz catheter insertion, the CVP line is considered a component of the line placement, and is not reimbursable. Only the Swan–Ganz line is reimbursable with 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

You can be reimbursed for central lines such as 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) if a second central line is medically necessary and if second central line is placed in a different anatomical site. The anesthesiologist's records should clearly document either of these scenarios to support the billing.