Radiology Coding Alert

Question: The physician began an encounter trying to insert a Swan Ganz catheter but decided to insert a PICC instead. Should we report 93503-52 with 36569?

Ohio Subscriber

Answer: For this encounter, you should report only 36569 (Insertion of peripherally inserted central venous catheter [PICC], without subcutaneous port or pump; age 5 years or older).

Support: "If a physician does not complete the insertion of one type of catheter and subsequently inserts another at the same patient encounter, only the completed procedure may be reported," according to the Correct Coding Initiative (CCI) manual, chapter 11, section I.23. "CPT® code 93503 (insertion and placement of flow directed catheter (e.g., Swan Ganz)) should not be reported with CPT® codes 36555-36556 (insertion of non-tunneled centrally inserted central venous catheter) or CPT® codes 36568-36569 (insertion of peripherally inserted central venous catheter) for the insertion of a single catheter."

Note that if the patient required both the Swan-Ganz and a separate PICC line, and the physician inserted both, then you could report both. In that case, you should append modifier 59 (Distinct procedural service) to 36569 to indicate the separate nature of the service.