General Surgery Coding Alert

General surgery coders, rejoice: For 2004, CPT completely revamps the catheter and line placement access codes, which will result in much greater specificity when reporting these procedures.
 
"Probably the most interesting changes to CPT for 2004 involve the reorganization of the central line and port codes, which includes whole new subsections for line and port placement, revision and removals," says Paulette B. Stone, CPC, RCC, quality assurance specialist at Public Employees Health Program, a nonprofit health program in Utah. "The ability to report these services with greater accuracy should improve reimbursement, as well."
 

Insertion of central venous access device (13 codes: 36555-36571)
Repair of central venous access device (2 codes: 36575/36576)
Partial replacement of central venous access device (catheter only) (1 code: 36578)
Compete replacement of central venous access device through same venous access site (6 codes: 36580-36585)
Removal of central venous access device (2 codes: 36589/36590)
Mechanical removal of obstructive material (2 codes: 36595/36596)
Other central venous access procedures (1 code: 36597). To make way for the new codes, CPT 2004 deletes catheter placement codes 36488-36493 and revision/removal codes 36530-36537.
 
"We had memorized a lot of the codes that are now being deleted, so remember to look closely at CPT 2004 to select the right PICC line and tunneled catheter codes," says Kay Tracy, BS, RCC, lead coder at the Oregon Clinic's radiology department. "We were accustomed to choosing codes according to patient age and between non-tunneled or tunneled lines," she continues. "The new codes further break down the procedures by insertion site [central or peripheral], use of subcutaneous port or pump, and use of one or two catheters/access sites."
 
The new level of specificity also means that surgeons must dictate and document their services more carefully than ever before so coders can select the most accurate code. On the plus side, CPT now uses language closer to what surgeons themselves use, which should aid in selecting the appropriate codes.
 
New Fluoroscopy Codes Also Improve Specificity
 
CPT 2004 includes a new fluoroscopic guidance code to use with the central line placement codes - +75998 (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]). CPT also adds code +76937 (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]) to describe guidance along with evaluation of a potential access [...]