General Surgery Coding Alert

Pay attention to procedure description, not brand names, when identifying venous access devices

If you're trying to sort through the 13 codes that describe placement of venous access devices (36555-36571), ask yourself five questions to ensure coding success. 1. One Access Point or Two? In the (relatively uncommon) case when the surgeon inserts a tunneled CVA device requiring two catheters with two different access sites (also known as a Tesio catheter), you can narrow your code selection to just two codes, 36565 and 36566, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. (see "Know the CVA Placement Codes" later in this issue for complete definitions).

If your surgeon's documentation describes a double catheter access device as defined by 36565 or 36566, skip ahead to question 5 to select the appropriate code. Otherwise, move on to question 2. 2. How Old Is the Patient? Because CPT divides most of the CVA codes into "under 5" and "age 5 years or older" categories, you can automatically eliminate almost half your code choices simply by knowing the patient's age, Jandroep says.

For patients under age 5, you narrow your code choices to 36555, 36557, 36560, 36568 and 36570 (plus 36563, see below).

For patients 5 years old or older, you can concentrate on codes 36556, 36558, 36561, 36569 and 36571 (plus 36563, see below).

Watch for the exception: One venous access code, 36563, does not designate the patient's age. Because 36563 does not specify "under 5 years of age" or "age 5 years or older," you should not rule out this code based on the patient's age, Jandroep says. 3. Central or Peripheral Insertion? Now, check your documentation to see if the surgeon inserted the access device centrally or peripherally. To determine this, you must know exactly which vessel the venous access device accesses.

A centrally inserted device usually enters the jugular, subclavian or femoral vein, or sometimes the inferior vena cava. A peripherally inserted device (often identified as a PICC line in surgeon documentation), in contrast, accesses the central venous system via the basilic or cephalic vein, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.

Again, the process of elimination allows you to narrow your code selection. For a centrally inserted access device, you must choose among 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565 and 36566.

Remember: 36565 and 36566 describe a double catheter access device, so you should have already eliminated these choices, as well.

For a peripherally inserted device, your choices are 36568, 36569, 36570 and 36571.

Example: The surgeon inserts a central venous access device with a single access site [...]