General Surgery Coding Alert

Question: Our surgeon inserted a central venous access catheter in a 4-year-old patient’s internal jugular vein to administer medication. The catheter’s tip terminated in the subclavian. How should I code this service?

Montana Subscriber

Answer: You should report 36555 (Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age) for this procedure.

The patient’s age is key to code selection for catheter placement. For example, if your provider performed the same service on a patient aged five or more years, you would instead report 36556 (… age 5 years or older).

The type of catheter is also important to code selection. For example, in your situation, the catheter is non-tunneled. On the other hand, if your surgeon had inserted a tunneled centrally inserted central venous catheter without a subcutaneous port or pump in your 4-year-old patient, you would report 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age).