General Surgery Coding Alert

Question: How would the following vascular catheters be coded: ASH, Tessio, double lumen and triple lumen? Indiana Subscriber Answer: There are several brands of vascular catheters, such as Port-A-Cath, Hickman and Tessio, to name a few. Physicians may use different catheters for different procedures and then use the catheter's brand name as a kind of shorthand to describe the procedure in which the catheter was used.

For coding and reimbursement, the catheter's brand name is irrelevant. What matters is the procedure that was performed and documented. Unfortunately, the coder may be unfamiliar with the surgeon's shorthand and may be unsure how to code the procedure. As a result, coders may select 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), but the appropriate code, based on what the surgeon did, is 36533 (Insertion of implantable venous access device, with or without subcutaneous reservoir). To make sure you code these procedures correctly, you should review the surgeon's procedure notes. Once you know how the catheter was inserted into the body, you can bill without further difficulty.

To distinguish between the procedures, look for the same key word the carriers look for, "tunneling." Typically, 36533 is used for central venous access devices that are either completely or partially implanted and involves at least two incisions and the creation of a subcutaneous tunnel with blunt dissection. Catheters implanted this way are usually intended to provide long-term access for chemotherapy and dialysis, among other things.

Code 36489 is a less complicated procedure that involves forming a short subcutaneous tract to place a peripherally inserted central catheter (PICC) line or triple-lumen catheter. It is usually performed on patients in intensive care units or for temporary dialysis access.