Radiology Coding Alert
Port Coding
Iowa Subscriber
Answer: The simpler of the two procedures is the placement of central venous catheters or peripherally inserted central catheter (PICC) lines. The catheters are intended for short- or medium-term use, and are implanted via the subclavian, brachiocephalic, innominate or iliac veins. PICC lines are inserted through an arm vein and threaded through the venous system so that the distal tip is in the target central vein
Coders choose from one of four codes when central venous lines are inserted, depending on the procedures used by the interventional radiologist. Percutaneous insertion is reported with 36488 (Placement of central venous catheter [subclavian, jugular or other vein] [e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, age 2 years or under) or 36489 ( percutaneous, over age 2). The radiologist pierces the skin and places the central line directly into the vein. Alternatively, 36490 ( cutdown, age 2 years and under) and 36491 ( cutdown, over age 2) would be assigned when the line is positioned in a vein that can be visualized through the incision.
But placement of a partially implanted venous access device (a tunneled line), requires the interventionalist to make two incisions and create a tunnel between them, where the device is then placed. Access ports like these are intended for long-term use in patients requiring treatment like chemotherapy or dialysis. In some cases, the port is completely implanted with a percutaneously accessible reservoir, while in others it is only partially implanted. Both procedures would be coded with 36533 (Insertion of implantable venous access device, with or without subcutaneous reservoir).
You Be the Coder and Reader Questions were answered and reviewed by Donna Richmond, RCC, CPC, radiology coding specialist with Acadiana Computer Systems Inc., a medical billing management company based in Lafayette, La., that serves more than 200 radiologists, pathologists and anesthesiologists; and Gary Dorfman, MD, FACR, FSCVIR, past president of the Society for Cardiovascular and Interventional Radiology (SCVIR) and president of Health Care Value Systems in North Kingstown, R.I.
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