ED Coding and Reimbursement Alert

Question: A patient presented in the ED and the physician placed a PICC line. A week later, the line became occluded and the doctor reinserted it. Can we charge for a second PICC insertion, or is the second procedure part of the global period for the original insertion? If a nurse inserts the line under the ED physician's supervision, can we charge for it?


New Hampshire Subscriber


Answer: The common code for emergency department-inserted adult PICC lines - 36569 (Insertion of peripherally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older) - assumes a fresh insertion, rather than a change over a guidewire or through the same site. If the physician reinserted through the same site, you should use 36584 (Replacement, complete, of a peripherally inserted central venous catheter, without subcutaneous port or pump, through same venous access) instead. This code has a 0-day global period and represents a complete procedural work process, so rebilling is OK. However, if the nurse placed the line, the physician can't bill for placement.