Oncology & Hematology Coding Alert

Question: Is there a code for pulling/removing a PICC line in the office? This is not a surgical procedure, merely pulling the line and dressing the site.

Texas Subscriber

Answer: You don't have a separate code for removal of a central venous catheter (CVC) such as a PICC line if you only have to remove the skin sutures holding the catheter in place. Instead, you include this service in the E/M code you report for that date of service.

The December 2004 CPT Assistant states, "The work required for removal of a nontunnelled [CVC] catheter is considered, from a CPT coding perspective, to be inherent to the evaluation and management visit in which it is performed."

Essentially, the AMA considers the removal of the nontunnelled PICC line to be included in other services and not a separately billable event. Of course, written insurance payer guidelines will take precedence.

If the catheter is "tunneled" under the skin, you do have separate procedure codes to report that device removal: 36589 (Removal of tunneled central venous catheter, without subcutaneous port or pump) and 36590 (Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion).

Don't miss: CPT 2008 contains a new code for blood draw from a PICC or peripheral catheter, 36592, Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified. See "At Last -- a Code for Multiple Pushes of the Same Drug" in Vol. 10, No. 1 of Oncology & Hematology Coding Alert for more information.