General Surgery Coding Alert

Question: May we bill separately for a central venous line (36489) placed at the same time as a major procedure? I was taught that if the line was placed in the operating room, I could not bill.

Tennessee Subscriber

Answer: Yes, you may bill 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyper-alimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) as a separate procedure with modifier -59 (Distinct procedural service) appended, when warranted. Note in addition that 36489 is modifier -51 (Multiple procedures) exempt.

Unlike 36489, codes with the term "separate procedure" in their descriptors (for example, 36410*, Venipuncture, child over age 3 years or adult, necessitating physicians skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture) are by definition an integral component of a more complex service, and therefore you should not usually report them independently. Only when the surgeon performs the service alone (absent the more extensive procedure of which it is normally a part) may you claim it. When you report such a service independently, you must append modifier -59 to further identify it as a distinct procedure.

Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, HIM program coordinator at Clarkson College in Omaha, Neb.