General Surgery Coding Alert

Question: If the nurse can't start an IV on a pediatric (3-year-old) patient, can the surgeon report the service separately using 36489?

South Carolina Subscriber

Answer: Code 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) describes placement of a central line catheter terminating either in the subclavian, brachiocephalic, innominate or iliac veins or at the junction of one or more of these veins and the superior or inferior vena cavae, rather than a typical IV, which is usually placed in the back of the hand or upper forearm. You would more appropriately report the placement of such an IVusing 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and, as necessary, +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]).

If the surgeon places a central line catheter, you may report 36489 if the descriptor for the more extensive procedure billed at the same time does not already include the placement. The National Correct Coding Initiative (NCCI), however, extensively bundles placement of an IV as described by 90780/90781 with surgical procedures. For payers that follow NCCI, in most cases the service is not separately reimbursable unless it is the only one provided.