Superb tricks for Cpt code for Tunneled Central Venous Catheter

Tunneled Central Venous Catheter
Triple lumen in jugular vein (Photo credit: Wikipedia)

What is Tunneled Central Venous Catheter?

A central venous access catheter (CVAC) is a tube that the physician inserts beneath the skin to draw blood or administer medication or nutrients to the patient. There are several types of CVACs, including tunneled central venous catheter (Hickman or Broviac), peripherally inserted central catheters (also called PICC lines or long lines), dialysis catheters, and implantable ports.

The codes you'll use when your surgeon inserts these access devices include the following:
36555 -- Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age
36556 -- ... age 5 years or older
36557 -- Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age
36558 -- ... age 5 years or older
36560 -- Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age
36561 -- ... age 5 years or older
36563 -- Insertion of tunneled centrally inserted central venous access device with subcutaneous pump
36565 -- Insertion of tunneled centrally inserted central venous access device, requiring two catheters via two separate venous access sites; without subcutaneous port or pump (e.g., Tesio type catheter)
36566 -- ... with subcutaneous port(s)
36568 -- Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age
36569 -- ... age 5years or older
36570 -- Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age
36571 -- ... age 5years or older.

Navigating your way though CPT 's 13 central venous access (CVA) codes can be more of a challenge than inserting the device itself. Use these five questions to quickly access the correct placement code from 36555-36571. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.

CPC Practice Exam - Medical Coding Study Guide Please Click Here!

Questions arise while coding Tunneled Central Venous Catheter

Question 1: Was There One Access Point or Two?

In the (relatively uncommon) case when the physician inserts a tunneled CVA device requiring two catheters with two different access sites (also known as a Tesio catheter), you can narrow your code selection to just two codes: 36565 and 36566.

If your physician's documentation describes a double catheter access device as defined by 36565 or 36566, skip ahead to question 5 to select the appropriate code. Otherwise, move on to question 2.

Question 2: How Old Is the Patient?

Because CPT divides most of the CVA codes into "younger than 5" and "age 5 years or older" categories, you can automatically eliminate almost half your code choices simply by knowing the patient's age.
For patients under 5 years of age, you can narrow your code choices to 36555, 36557, 36560, 36568, and 36570 (plus 36563).

For patients age 5 and older, you can concentrate on 36556, 36558, 36561, 36569, and 36571 (plus 36563).

Exception: One venous access code, 36563, does not designate the patient's age. Because 36563 does not specify "younger than 5 years of age" or "age 5 years or older," you should not rule out this code based on the patient's age.

Question 3: Did the Physician Perform a Central or Peripheral Insertion?

Check your documentation to see if the physician inserted the access device centrally or peripherally. To determine this, you must know exactly which vessel the venous access device accesses.

A centrally inserted device usually enters the jugular, subclavian, or femoral vein, or sometimes the inferior vena cava. A peripherally inserted device (often identified as a PICC line in physician documentation), in contrast, accesses the central venous system via the basilic or cephalic vein.

Again, the process of elimination allows you to narrow your code selection. For a centrally inserted access device, you must choose among 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, and 36566.

Remember: Codes 36565 and 36566 describe a double catheter access device, so you should have already eliminated these choices, as well.

For a peripherally inserted device, your choices are 36568, 36569, 36570, and 36571.
Example: The physician inserts a central venous access device with a single access site into the jugular vein of a 4-year-old patient.

Because the device has one access point, you can rule out a Tesio-type catheter (36565, 36566). Because the patient is younger than 5 years of age, you needn't consider 36556, 36558, 36561, 36569, or 36571. And because the procedure describes a centrally inserted device, you can also look past 36568, 36569, and 36570.

This leaves you to select from 36555, 36557, 36560, and 36563. To further narrow your selection, move on to the next question.

Question 4: Was the Catheter was Tunneled central venous catheter or PICC?

Determine whether the physician tunneled the catheter under the skin or left it exposed. Tunneling describes a technique in which the physician places a long catheter under the skin between the vein entry and external access sites.

These catheters may have a subcutaneous cuff to help secure them in the tunnel. If the physician intends to use the line for prolonged periods, tunneling makes it more difficult for bacteria to migrate along the catheter into the blood stream.

Codes for tunneled catheters include 36557, 36558, 36560, 36561, 36563, 36565, and 36566.
For non-tunneled catheters, your choices include 36555, 36556, 36568, 36569, 36570, and 36571.

Example: Continuing with the earlier example, we'll assume that the physician does, in fact, tunnel the catheter. This further narrows your code choices for this example to 36557 and 36563.

Question 5: Did the Access Device Have a Pump and/or Port?

You must consider whether the access device the physician places includes a subcutaneous port and/or pump for injecting and/or administering medication directly into the vein.

Codes describing venous access devices without a pump or port include 36555, 36556, 36557, 36558, 36565, and 36568. For a venous access device with a pump or port, your choices are 36570 and 36571. Codes 36560, 36561, and 36566 describe procedures with a port only, whereas 36563 describe a procedure with a pump only.

Example: Returning again to our example, a review of the documentation shows that the access device does not include a subcutaneous port or pump. Therefore, the appropriate code in this case is 36557.

Beware 'Brand Names'

Avoid coding catheter placement using only brand names or without complete documentation of the procedure because physicians may use many popular types of catheters in several different ways.
As a general rule, Hickman, Broviac, and Groshong catheters are tunneled, while Hone and triple-lumen catheters are non-tunneled. Although these terms can provide a clue to proper coding, you should not rely on them exclusively. Read the operative note's details to be sure of the exact type of CVA the physician perform. Likewise, if the physician documents placement of a Tesio-type catheter be sure the device has two separate access sites before reporting 36565 or 36566.

Make Your Venous Access Coding Easy with This Chart

Solve This Central Venous Access Scenario

Think you've got venous catheter reporting down pat? See if you can select the proper code for this procedure to find out for sure.

Operative report: The physician preps and drapes the left arm of a 50-year-old patient in sterile fashion. He then performs ultrasonographic guidance and gains access to the left basilic vein using a 22-gauge angiocatheter. He then secures access with a #18 guidewire and introduces a 4.5 French coaxial system.
He chooses the appropriate length of PICC line, and advances a single-lumen, 4 French PICC line to the level of the junction of the proximal-to-mid superior vena cava.

Patient tolerates the procedure well with no apparent complications.

The correct code is:
A. 36558
B. 36571
C. 36569
D. 36561

Answer: The correct answer is C. You should report 36569 for this procedure.

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