More Than Brand Name Needed to Correctly Code for Insertion of Vascular Catheter for Venous Access
Published on Wed Sep 01, 1999
Scenario: A surgeon is asked to insert a Port-A-Cath for chemotherapy three weeks after a partial mastectomy with axillary node dissection was performed. The primary diagnosis was 459.89 (collateral circulation [venous], any site; phlebosclerosis; venofibrosis), while the secondary ICD-9 was 174.4 (malignant neoplasm of female breast, upper-outer quadrant).
In the scenario above, many coders often select the wrong code: Instead of 36533 (insertion of implantable venous access port, with or without subcutaneous reservoir), they sometimes code the procedure with 36488 (placement of central venous catheter [subclavian, jugular or other vein][e.g., for central venous pressure, hyperalimentation, hemodialysis or chemotherapy]; percutaneous, age 2 years or under) or 36489 (percutaneous, over age 2).
Much of the confusion stems from the fact that physicians often document the brand name of the device in the patients chart and not what procedure was actually performed, says Jacqueline Leopold, CPC, president of Practice Management Consulting Corp. in Highland Park, IL. However, knowing the catheters brand name does not necessarily help the surgeons staff file the procedure correctly.
Coders need to understand the two codes that are available, and physicians need to become more aware that, even though they know what procedure was performed, they need to communicate it more accurately to their staff and stop using the catheters brand name to indicate the procedure, Leopold, whose clients include general surgeons says.
Among the better-known brand names are Port-A-Cath, Perm Cath, Broviac, Groshong, Hickman and Tessio. But if your coder doesnt know which of these catheters are used for which procedure, it will be extremely difficult for him or her to code correctly. And many coders have never even seen a catheter.
Knowing Op Report Key Words Essential to Correct Coding
What coders need to do, says Kathleen Mueller, RN, CPC, CCS-P, a physician reimbursement specialist in the office of Allan L. Liefer, MD, a general surgeon in Chester, IL, is read through the procedure section of the operative report to find out how the catheter was inserted. Looking at the top of the report is not enough: Typically, it will say insertion of Groshong or insertion of Hickman, which is completely understandable for the surgeon but not for the coder.
Once the coder is aware of how the catheter was actually inserted into the body, he or she can proceed to bill without further difficulty.
The key word the coder should look for to distinguish between the procedures is tunneling. According to a Medicare Bulletin issued for the state of Ohio, 36533 should be used for both completely and partially implanted devices that are employed for central venous access. This applies is more states than Ohio, but not all, so check with your local carrier. The procedure involves at least two incisions and [...]
