General Surgery Coding Alert

Coding for venous access often involves the reporting of related procedures. First among these are removal, revision, or maintenance of catheters.

CPT does not include a code for removal of a central venous catheter (CVC). Rather, removal is included in the placement code and cannot be separately reported. If the surgeon examines the patient and performs the components of an E/M service, however, you may claim the appropriate E/M service code. And, if an embedded catheter that's been in place for a long time requires extensive effort to remove due to scar tissue, the AMA recommends reporting 37799 (Unlisted procedure, vascular surgery) to recoup some reimbursement, says Jan Rasmussen, CPC, president of Professional Coding Solutions, an Eau Claire, Wis.-based coding support and compliance review firm. Documentation should clearly demonstrate the unusual nature of the removal to substantiate billing.

Likewise, no codes exist to report maintenance, or flushing, of a catheter or partially implanted catheter. To report maintenance performed by the office personnel under the supervision of a physician without an additional E/M, assign 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...). If the physician provides an E/M service on the same day, the catheter maintenance is included in the larger E/M service.

Revision of CVC is reported 36534 (Revision of implantable venous access device, and/or subcutaneous reservoir). The physician must completely revise the catheter to claim this code: If only the tip is moved, 36493 (Repositioning of previously placed central venous catheter under fluoroscopic guidance) is appropriate.

You may report catheter placement separately when provided with critical care codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 ( each additional 30 minutes [list separately in addition to code for primary service]), although the time spent placing the catheter may not be counted toward the overall critical care time. Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the critical care codes.

Note that 36488-36491 are "starred" procedures and therefore are modifier -51 (Multiple procedures) exempt. As such, these procedures should be reimbursed at their full value even if they are provided at the same time as other separately reportable procedures.