CPT Coding guidelines of Central Venous Access procedure

1. Coding guidelines for Central Venous Access procedure

1. CPT Coding guidelines
2. Uses of Central Venous Access procedure

· Administration of medication – Antibiotic, chemotherapy drugs, other IV drug

· Administration of fluids and nutritional compounds

· Transfusion of blood products

• What is Tunneled Catheter

A tunneled catheter is a thin tube that is placed into a vein beneath the skin, allowing long-term access to the vein. A tunneled catheter is a thin tube that is placed into a vein but is then tunneled under the skin to anchor the catheter in place beneath the skin, allowing long-term access to the vein without any fear of being dislodged. This anchor under the skin is provided by a small cuff that allows tissue to grow around the catheter thereby providing stability to the catheter and preventing catheter movement. Most are placed in the neck but can also be placed in the groin, liver, chest, or back.

• What is non Tunneled Catheter

Non-tunneled catheters are commonly used for temporary venous access and may be placed into a large vein near the neck, chest, or groin. In emergency situations, a non-tunneled catheter provides easy access to the bloodstream and allows quick delivery of medicines and fluids. For long-term access, specialized non-tunneled catheters with valve mechanisms may also be used to help prevent infection and catheter-associated blood clots called thrombosis.

• Two types of Central venous Access device:

1. Centrally inserted (jugular, subclavian, femoral vein or inferior vena cava catheter entry site)
2. peripherally inserted (Basilic, cephalic, or saphenous vein entry site)

The device may be accessed by following approach 

• ·Via exposed catheter (external to the skin)
• Via a subcutaneous port
• Via a subcutaneous pump

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The procedures involving these types of devices fall into five categories

1. Insertion (placement of catheter through a newly established venous access)
2. Repair (fixing device without replacement of either catheter or port/pump, other than pharmacologic or mechanical correction of intracatheter or pericatheter occlusion [see 36595 or 36596])
3. .Partial replacement of only the catheter component associated with a port/pump device, but not entire device
4. Complete replacement of entire device via same venous access site (complete exchange
5. Removal of entire device

Central Venous Access Coding based on following categories :

• Age of the patient
• Central or Peripheral
• Non tunneled
• Tunneled
• Port

Placement of catheter through a newly created venous access.

CPT Codes 36555 – 36571

 

 

	Centrally inserted		Peripherally inserted
– Non tunneled	36555, 36556	without imaging guidance	36568, 36569
Tunneled	36557, 36558	with imaging guidance	36572, 36573
Port	36560, 36561	with port	36570, 36571
Pump	36563

For Repair / Replacement / Removal as follows

• Central or peripheral inserted catheter
• Tunneled or non-tunneled
• With or without port / pump

1. CPT Coding guidelines

• If an existing device is removed and a new one is placed via a separate venous access site may be coded both (Removal of old and insertion of new)
• If imaging guidance is used for gaining access and manipulating the catheter into final position.
• Should be coded 76937 and 77001
• Chest X-ray for the purpose of the final catheter position on the same day of service should not be coded with 36572, 36573, and 36584.
• If catheter tip location is not confirmed – add mod 52 with 36572, 36573, and 36584.
• Midline catheters are not central venous access device – Use 36400, 36406 or 36410
•  Codes 71045, 71046, 71047, 71048 should not be reported for the purpose of documenting the final catheter position on the same day of service as 36572, 36573, 36584.
• Do not use 76937, 77001 in conjunction with 36568, 36569, 36572, 36573, 36584.