Inpatient Facility Coding & Compliance Alert

Many healthcare professionals can place PICC lines (peripherally inserted central venous catheters) for patients in a hospital setting. Coding from a physician standpoint depends on who inserts the line. When you're billing from the facility side, however, remember that your coding doesn't change, no matter which professional inserts the line (MD, RN, NP, PA, or CNS).

Be sure to capture every component of the service:

•PICC line insertion – Report 36568 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age) or 36569 (... age 5 years or older) for the procedure, based on the patient's age. •Ultrasound guidance – Providers often will use ultrasound guidance when placing the PICC line to ensure it ends at the correct place. Some payers or facilities require guidance, so check the applicable guidelines. You'll report add-on code +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]).

• PICC device – Bill the device under Revenue Code 278 (Other implants) with HCPCS code C1751 (Catheter, infusion, inserted peripherally, centrally or midline [other than hemodialysis]).

Reimbursement for PICC line insertion is part of the DRG payment for the entire case, and Medicare doesn't reimburse hospitals for ultrasound guidance used for venous access. However, it's still important to report all aspects of the service so those costs will be considered for future payment updates.

Definition:Central venous catheters (such as a PICC line) are longer than other types of catheters, and travel from a vein in the patient's arm or leg into one of the large veins near the heart. Having a termination point near the center of the patient's body allows for treatment that could not be completed from standard periphery IV access.