Cardiology Coding Alert

Question: How should I code a non-tunneled Port-a-Cath placement under fluoroscopy for a 56-year-old patient? There was a 4 cm incision made to incorporate the guidewire in the infraclavicular area.

Codify Member

Answer: Because the case involves a Port-a-Cath, you need a tunneled code, such as 36561 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older), rather than a non-tunneled code.

Here's why: According to CPT® Assistant (December 2009), "it is not procedurally possible to insert a catheter with a port attached in a manner that is not tunneled." According to the article, "tunneled" means the physician creates a subcutaneous pocket for an implanted central venous access port "with the catheter being tunneled from the vein of choice through the subcutaneous tissue to the implanted central venous device. The central venous catheter is then internally connected to the port device."

You also should verify the precise vein used for insertion as this affects coding. Insertion in the jugular vein, subclavian vein, femoral vein, or inferior vena cava qualifies as centrally inserted. Insertion through a vein such as the basilic or cephalic is peripheral insertion. The physician's documentation of "infraclavicular" (below the clavicle) suggests central insertion, but the documentation should specify the vein to support proper coding.