Anesthesia Coding Alert

Question: One of my doctors is asking about the proper code to use for placement of a central line with a catheter that runs through the external jugular and ends in the subclavian vein. He wants to confirm that we should bill 36556. Normally with a central line, the physician uses a guidewire for placement, but he did not use one in this case. Is the external jugular considered peripheral or central? What's the proper code for this?

Ohio Subscriber

Answer: Since the external jugular is considered central, you would indeed use 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older). The introductory section of the CPT manual that includes 36556 states: "To qualify as a central venous catheter or device, the tip of the catheter/device must terminate in the subclavian, brachiocephalic(innominate), or iliac veins ...," which corresponds to your physician's notes that the catheter ends in the subclavian.

CPT also notes that "the venous access device may be either centrally inserted (jugular, subclavian, femoral vein, or inferior vena cava catheter entry site) ..." Note that this line insertion is a non-routine monitoring service, and that 36556 is a surgery code. The procedure is, therefore, paid at a flat fee and does not include a time component.