Cardiology Coding Alert

Remember: Never report 36568 or 36569 in conjunction with +76937 or +77001.

If your cardiologist places a peripherally inserted central venous catheter (PICC), you must read the medical documentation carefully for details like the age of the patient, whether the cardiologist used imaging guidance or not, and if he used a subcutaneous port or pump. Not knowing these details could negatively impact your claims.

Read on to learn more.

Report These Codes for PICCs Without Imaging Guidance

If the cardiologist places the PICC without imaging guidance, you should look to the following two codes. Note: With these codes, the cardiologist does not use a subcutaneous port or pump:

• 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
• 36569 (…; age 5 years or older)

Don’t miss: You must pay close attention to the medical documentation to see the age of the patient. If the patient is younger than 5 years old, report 36568. On the other hand, if the patient is 5 years old or older, you should report 36569.

Caution: You should never report codes 36568 or 36569 in conjunction with ultrasound guidance codes +76937 or fluoroscopic guidance code +77001, according to the CPT^® guidelines.

Look to 3 Options With Imaging Guidance

When the cardiologist uses imaging guidance such as ultrasound or fluoroscopy for the PICC placement or complete replacement, you should look to the following codes. Note: With these codes, the cardiologist does not use a subcutaneous port or pump:

• 36572 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age). Note: Use this code when the patient is younger than five years old.
• 36573 (…; age 5 years or older) Note: Use this code when the patient is 5 years or older.
• 36584 (Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement) Note: Use this code for the complete replacement of the PICC.

Codes 36572, 36573, and 36584 include “all imaging necessary to complete the procedure, image documentation (representative images from all modalities used are stored to patient’s permanent record), associated radiological supervision and interpretation, venography performed through the same venous puncture, and documentation of final central position of the catheter with imaging,” per the CPT^® guidelines.

Don’t miss: If the cardiologist uses ultrasound to place the PICC, he must include the following information in the medical documentation: the evaluation of the potential puncture sites, the patency of the entry vein, and real-time ultrasound visualization of the needle entry into the patient’s vein.

“Remember, in order to meet the guidelines for reporting ultrasound code +76937, ultrasound guidance procedures also require permanently recorded images of the site to be localized in the patient’s medical record,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC.

CPT^® also identifies the following tips you should follow when reporting 36572, 36573, and 36584.

Tip 1: Never report 36572, 36573, or 36584 in conjunction with +76937 or +77001.

Tip 2: Never report 71045 (Radiologic examination, chest; single view)-71048 (… 4 or more views) to document the final catheter position on the same day of service as 36572, 36573, or 36584.

Tip 3: Since 36572, 36573, and 36584 include confir­mation of the catheter tip location, the cardiologist who reports image-guided PICC insertion cannot report the confirmation of the catheter tip location separately.

Tip 4: If the cardiologist performs a 36572, 36573, or 36584 service but does not confirm the catheter tip’s location, you should append modifier 52 (Reduced services) to the appropriate code.

Rely on 36570 and 36571 When Cardiologist Uses Subcutaneous Port

On the other hand, if the cardiologist inserts the PICC with a subcutaneous port, you could look to the following codes:

• 36570 (Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age) Note: Report this code for a patient younger than 5 years.
• 36571 (Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older) Note: Report this code for a patient 5 years or older.

Caution: Codes 36570 and 36571 apply to PICCs with a subcutaneous port. However, if your cardiologist places a tunneled centrally inserted central venous access device with a subcutaneous port instead, you should report 36560 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age) or 36561 (… age 5 years or older), depending upon the age of the patient.

“PICCs are not tunneled, so if you see documentation of a ‘tunneled PICC,’ this generally refers to placement of a catheter in a central vein like the internal jugular and for coding purposes, according to the Society of Interventional Radiology (SIR), it would be considered a tunneled central venous catheter,” Peterson says.