Radiology Coding Alert

Question: My interventional radiologist created a small incision over the patient’s vein in his forearm and inserted a guidewire. Under imaging guidance, the radiologist introduced a central venous catheter and moved it forward over the guidewire until it reached the superior vena cava. They then made an incision in the patient’s chest and created a separate pocket to place a port just under the skin. Next, they inserted the port in the pocket and connected it to the catheter. Finally, the radiologist closed both of the incision sites by suturing the skin. The patient is four years old. What CPT^® code should I report for this procedure?

Texas Subscriber

Answer: You should report 36570 (Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age). This is an example of the radiologist inserting a peripherally inserted central venous catheter (PICC) with a subcutaneous port.

On the other hand, if your radiologist inserts a PICC with a subcutaneous port for a patient who is five years or older, you should report code 36571 (Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older).

Caution: Codes 36570 and 36571 apply to PICCs with a subcutaneous port. However, if your radiologist places a tunneled centrally inserted central venous access device with a subcutaneous port instead, you should report 36560 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age) or 36561 (… age 5 years or older), depending upon the age of the patient.

Coding tip: PICCs are not tunneled, so if you see documentation of a “tunneled PICC,” this generally refers to placement of a catheter in a central vein like the internal jugular, and for coding purposes, according to the Society of Interventional Radiology (SIR), it would be considered a tunneled central venous catheter.