Catheter Tip Placement Impacts Venous Access Coding
Published on Mon Apr 01, 2002
" A cardiologist may be required to place a central line in a patient with heart failure or cardiogenic shock. The central line, also known as a central venous catheter (CVC), provides medication and fluids to a patient who cannot have a peripheral line placed or who needs medications that are more appropriately administered through a central line. To correctly report the procedure as a central line placement, the cardiologist must document the indication for the CVC placement and the catheters final destination.
To insert a central line, the cardiologist places the catheter percutaneously into a vein (subclavian, jugular or femoral) then maneuvers the catheter tip into either the inferior or superior vena cava, or the right atrium. The other end of the catheter is left out of the body to act as a port to supply medication and nutrients and monitor venous pressure, among other things.
Although central lines are frequently associated with the brand name of a particular catheter (some well-known brands are Triple Lumen and Quad-cath), the make of catheter is not a factor when reporting the procedure, notes Kathleen Mueller, RN, CPC, CCS-P, a cardiology coding and reimbursement specialist in Lenzburg, Ill. In addition, the length of the catheter and the number of catheter lumens (lines) need not be considered.
The code most commonly used to report central line placement is 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2).
To correctly bill a true central line, the cardiologist must document that the catheter tip was positioned in either the superior or inferior vena cava or in the right atrium, Mueller says. The site where the catheter is inserted is not a factor, and insertions into the subclavian, femoral or any other vein are coded identically.
If the catheter was not advanced as far as that, a central line placement has not been performed, she adds. Nurses typically perform these placements (known as midline catheters), which are reported using 36000* (Introduction of needle or intracatheter, vein).
Midline catheters may be confused with peripherally inserted central catheters (known as PICC lines), which are usually placed by a nurse (when they are midline catheters) but are positioned by a cardiologist if the catheter is advanced to either vena cava or the right atrium.
Note: If the nurse is unable to get the IV started and the cardiologist is called in for that reason only, only 36000* should be reported. A separate E/M service should not be billed, because there is no [...]
