General Surgery Coding Alert

Question: What code should we bill when we remove a central venous pressure (CVP) line and insert a Hickman catheter at a different site?

New York Subscriber

Answer: You can't determine the proper code based on type of catheter (such as CVP line or Hickman).

Selecting the proper code depends on the patient's age, whether the surgeon places the catheter centrally or peripherally, where the catheter tip is at the end of placement, and whether the catheter is tunneled or non-tunneled.

Surgeons typically place Hickman catheters as central lines, and they usually place them centrally, although they can be tunneled or non-tunneled. For an adult patient, that makes the most likely codes for your scenario either 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) or 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older).

Caution: Before using these codes, you should verify that there was no port or pump attached to the catheter. Also check to be sure that the catheter was actually placed into the subclavian, innominate, or iliac veins, the inferior or superior vena cava, or the right atrium through a central vein (such as jugular or femoral). If any of these facts don't match your case, you should select a code other than 36556 or 36558.

Tip: Carefully read the directions preceding 36555 before you choose the code. Don't guess if the procedure note doesn't specify everything that you need to know. Hickmans are versatile catheters and you can't be sure what the surgeon did unless it's in the note.

Separate removal: You can bill separately for the removal of a tunneled central line (such as 36589, Removal of tunneled central venous catheter, without subcutaneous port or pump), but not a non-tunneled line.