Radiology Coding Alert

Question: I would appreciate some help on the following report. Would I use CPT 76000 and CPT 36005 for the first injection reported?

Existing subclavian catheter is injected with contrast and imaging was performed. Dual lumen catheter tip is projected with the left brachiocephalic vein, tip is angulated against the venous wall. Decision made to exchange existing catheter. Left subclavian site is prepped. The existing catheter removed over a guidewire, dual lumen dialysis catheter is inserted and advanced to level of superior vena cava. Catheter secured with sutures. Spot film demonstrates catheter tip in superior vena cava.

How would the actual exchange be coded?

Ohio Subscriber

Answer: According to the Society of Cardiovascular and Interventional Radiology (SCVIR), replacement of a peripherally inserted central catheter (PICC) line over a guidewire, as described here, would be coded 36493 (repositioning of previously placed central venous catheter under fluoroscopic guidance. Code 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g. cardiac fluoroscopy]) also would be reported. But, many payers consider the verbiage under fluoroscopic guidance to mean that fluoroscopy is included in 36493 and would not pay this separately.

In addition, SCVIR recommends coders to assign 36005 (injection procedure for contrast venography [including introduction of needle or intracatheter]), appended with modifier -59 (distinct procedural service). Again, however, some coding experts consider the contrast injection for position and placement to be incidental to and included in 36493.