Wiki Central Cath Help needed please

[Robbin109]

36558 vs 36561 vs 36566 ??

Under ultrasound guidance, the right internal jugular vein was cannulated with a micropuncture needle, followed by wire and a microsheath. I then inserted the wire. A small incision was made in the neck and a conunter inciciosn as made in the chest. I then tunneled the catheter subcutaneously between two incisions. Tract was dilated over a wire. Peal-away sheat was placed. The inner dilator and wire were removed. The catheter was placed through the peel-away sheath, removing the sheath, leaving the catheter in place. Both ports were aspirated and flushed easily. Fluoroscopy confirmed good position. Ports were infused with heparin and capped. Catheter sutured into place and dressed.The neck incision was closed with 3.0 silk.

I did just watch the Dr. Z's webinar on these, but he doesn't address 36561 or 36563 at all. I read somewhere else that a pocket is required fr 36561? Looks like only one catheter was used so not sure about 36566 either.

Any help or guidance would be appreciated. Thank you

 

[thomas7331]

All catheters have ports, and a single catheter can have multiple ports, so don't let the mention of the ports confuse you on the coding. The main difference for coding purposes is whether or not the port is placed beneath the skin (subcutaneous) or not. You're correct that a subcutaneous port will usually involve the surgical creation of a 'pocket' into which the port will be placed. For the example you have included above, I would choose 36558 (assuming a patient over 5 years of age) since it is a single tunneled catheter but with no documentation that the ports were placed beneath the skin.

 

[Robbin109]

Thomas! Thanks!! that was a big help!!

 

[Robbin109]

One other question:

Do you code Z99.2 with acute kidney dx