General Surgery Coding Alert

Question: If the surgeon's documentation refers to a "PICC" line terminating in the subclavian vein, should I code it as a centrally inserted catheter because the subclavian is central?

South Dakota Subscriber

Answer: No, you should not use a code for a centrally inserted catheter for this service. "Inserted" refers to the access point (where the catheter enters the vascular system) rather than the termination point. If the documentation is correct that the procedure involved a peripherally inserted central venous catheter (PICC) line, you should see access from a vein such as the basilic or cephalic vein, according to CPT guidelines. For a peripherally inserted device, look to 36568-36569 (Insertion of peripherally inserted central venous catheter [PICC], without subcutaneous port or pump...) and 36570-36571 (Insertion of peripherally inserted centrally venous access device, with subcutaneous port ...).

In contrast: To be a central insertion, the access site must be in a vessel close to the central circulatory system, usually the jugular, subclavian, or femoral vein, or sometimes the inferior vena cava. For a centrally inserted access device, you choose from the following:

36555-36556 -- Insertion of non-tunneled centrally inserted central venous catheter ...

36557-36558 -- Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump ...

36560-36566 -- Insertion of tunneled centrally inserted central venous access device ....

CVA: CPT establishes that central venous access catheters or devices (whether peripherally or centrally inserted) must terminate in the subclavian, brachiocephalic (innominate), or iliac veins, the superior or inferior vena cava, or the right atrium.