Anesthesia Coding Alert

Question: One of our physicians is asking about the correct code 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?

New Mexico 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 states 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.