Radiology Coding Alert

Question: Which codes should we report when the radiologist inserts the following vascular catheters: Tesio, double lumen and triple lumen? Indiana Subscriber Answer: The Tesio-type catheter is a centrally inserted catheter with two separate venous access sites. CPT 2004 brought a specific code for inserting Tesio-type catheters: 36565 (Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; without subcutaneous port or pump [e.g., Tesio-type catheter]). Physicians generally insert the double and triple lumen catheters centrally, and these may or may not require tunneling. Again, CPT introduced new codes for 2004, and you must choose the correct code based on the patient's age. If the physician inserts a central catheter without tunneling for a patient under 5 years of age, use 36555 (Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age). If the patient is 5 years old or older, use 36556 (... age 5 years or older).

Be careful when coding for catheter placement using only brand names and descriptions without the description of the procedure. Interventionalists use many popular types of catheters in several different ways. To report the correct code you must know whether the physician placed the catheter peripherally or centrally, whether the procedure included tunneling, or if the physician placed the catheter to a reservoir or pump. -- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; Deborah I. Churchill, president of Churchill Consulting, Inc.; and Gary S. Dorfman, MD, FACR, FSIR.