Cardiology Coding Alert

Question: While providing critical care, the doctor inserted a tunneled central venous catheter under ultrasound guidance. May I report the catheterization in addition to 99291?

Codify Subscriber

Answer: You may report central venous catheter insertion in addition to 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). Remember to subtract the time required for catheterization from the 99291 total time. Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99291 to indicate it was separately identifiable from the catheterization.

Many factors go into choosing the proper catheterization code. A likely possibility for patients 5 and over is 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older), but base your code choice on the documentation.

For ultrasound guidance, look to +76937-26 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]), assuming the code definition requirements are met (such as permanent recording).

Tip: If the physician also uses fluoroscopic guidance, also report +77001 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [List separately in addition to code for primary procedure]).