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[Jess1125]

Hi,

I have a report for a Swan Ganz catheter placement which I don't have a problem with. He also said he placed a right internal jugular central venous line but not really familiar with that so wondering if he's got the right documentation and what the code would be.

"The patient was intubated and sedated in the cardiovascular ICU. She was prepped and draped in the usual sterile fashion. Local anesthesia was attained in the right neck using 1% Lidocaine. A 9 French Swan sheath was placed in the right internal jugular artery using the modified Seldinger technique. Landmarks were determined using ultrasound prior to starting the procedure. An 8 French balloon tipped Swan Ganz catheter was then floated into the wedge position, monitoring the pressure waveforms along the way. The balloon was deflated and the catheter was pulled back demonstrating a pulmonary arterial waveform. All of the ports had been flushed with sterile saline. A chest x-ray was obtained. The Swaz was deeply seated, so it was pulled back about 10 cm. It was still slightly deeply seated, so it was pulled back another 2 cm. The sheath was sutured into place and the rest of the catheter was taped down."

Jessica CPC, CCC

 

[theresa.dix@tennova.com]

Hi,

I have a report for a Swan Ganz catheter placement which I don't have a problem with. He also said he placed a right internal jugular central venous line but not really familiar with that so wondering if he's got the right documentation and what the code would be.

"The patient was intubated and sedated in the cardiovascular ICU. She was prepped and draped in the usual sterile fashion. Local anesthesia was attained in the right neck using 1% Lidocaine. A 9 French Swan sheath was placed in the right internal jugular artery using the modified Seldinger technique. Landmarks were determined using ultrasound prior to starting the procedure. An 8 French balloon tipped Swan Ganz catheter was then floated into the wedge position, monitoring the pressure waveforms along the way. The balloon was deflated and the catheter was pulled back demonstrating a pulmonary arterial waveform. All of the ports had been flushed with sterile saline. A chest x-ray was obtained. The Swaz was deeply seated, so it was pulled back about 10 cm. It was still slightly deeply seated, so it was pulled back another 2 cm. The sheath was sutured into place and the rest of the catheter was taped down."

Jessica CPC, CCC

Jessica,
If I remember correctly these two procedures are bundled unless there are two access sites and for different reasons. You would code the Swan Ganz. I'l try to confirm that.

 

[theresa.dix@tennova.com]

Jessica,
If I remember correctly these two procedures are bundled unless there are two access sites and for different reasons. You would code the Swan Ganz. I'l try to confirm that.

This might answer your question.

Answer: National Correct Coding Initiative does not bundle 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) and 93503 (Insertion and placement of flow directed catheter [eg, Swan-Ganz] for monitoring purposes), so you can report both codes on the same day. Some carriers may require that you append modifier 59 (Distinct procedural service) to indicate that the procedures were in fact distinctly separate.

Physicians consider the insertion of a central line (36556) to be an integral part of inserting a Swan-Ganz catheter (93503). In certain uncommon circumstances, however, the physician might need to insert a central line in one region of the body and the Swan-Ganz in another area. In this case, you would certainly want to report both procedures.

Tip: In addition, when a physician inserts a hemodialysis catheter you would report code 36556. This procedure may occur on the same day as a Swan-Ganz catheter insertion, so you would report both 36556 and 93503