General Surgery Coding Alert

Question:  When our vascular surgeon performs angioplasty, venography and stenting prior to placing a PICC line, is it appropriate to override the 36005/36569 edit?

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Answer: You are correct that the Correct Coding Initiative (CCI) bundles 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter]) into 36569(Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump age 5 years or older).

Experts advise that because 36005 is a catheter placement code, it is rolled into the payment for the interventional services (which require the same level of catheterization) performed at the same session, and recommend that you should not separately report 36005.

Bonus tip: If documentation reflects that the venography was diagnostic in nature, and not just road-mapping, you may report the appropriate radiological supervision and interpretation code for that service, such as 75820 (Venography, extremity, unilateral, radiological supervision and interpretation). Note that reporting diagnostic venography with 36569 is fairly rare, and you may need a modifier on the venography code depending on payer edits.