General Surgery Coding Alert

Question: Our surgeon performed a Swan-Ganz procedure, placed a central line through the same incision, and also placed an arterial line. How should we code these three procedures?

Florida Subscriber

Answer: Although you describe three procedures, you should report just two, in this case. Report the Swan-Ganz (93503, Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes) and the arterial line (36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous).

When your surgeon uses both a central line and a Swan-Ganz, the central line placement (36556, Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) is included in the Swan-Ganz (93503, Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes).

Exception: You can report both the central line and Swan-Ganz if your surgeon documents separate locations and placements for the central line and Swan-Ganz catheter. If you have clear documentation supporting the separate sites, append a modifier such as 59 (Distinct procedural service) or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to 36556.