Pulmonology Coding Alert

Question: A pulmonologist told me that I could not perform a Swan-Ganz without doing a central line first. In that case, can I bill for both procedures? Why or why not? Also, what is the difference between a Swan-Ganz catheter and a right heart catheter?

Arizona Subscriber Answer: If you insert only the Swan-Ganz catheter, you cannot report both the Swan-Ganz catheter insertion (93503, Insertion and placement of flow-directed catheter [e.g., Swan-Ganz] for monitoring purposes) and the central line insertion (for example, 36555, Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age). But if you put in another central line after inserting the catheter, you can report a central line code, such as 36557 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; under 5 years of age). You should attach modifier -59 (Distinct procedural service) to 36557 to show that your pulmonologist performed the central line insertion separately from the Swan-Ganz procedure.

The Swan-Ganz catheter insertion includes the access to the central venous system. Physicians use the catheters for right heart catheterization. The catheters are stiffer than central line catheters and don't have markings.