This page addresses follow-up questions and additional information pertinent to our webinar
Navigating Vascular Access Device Coding.
The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Our vascular nurses insert midline caths but they don’t document where the tip of the catheter is. How can we be sure it’s a midline catheter and not a PICC line?
A: Midline catheters don’t usually require imaging for guidance or to check placement because the catheter tip isn’t near the heart. Midline catheters are shorter than PICC lines, so if the nurse documents it as a midline catheter, you’re safe coding it as an IV placement, even if the catheter tip location is not known.
Q: Can the chest x-ray to check placement be reported in addition to the PICC line placement code if they find it is not in the correct position and then have to move it?
A: No. Chest X-rays to check placement are always bundled into the PICC line placement with imaging codes, even if they find the device is displaced. In such a case, there would be a code for the PICC line insertion with imaging and a second code for the repositioning.
Q: How do you code placement of a midline catheter under ultrasound guidance with the tip terminating in the subclavian vein?
A: By CPT definition, any catheter terminating in the subclavian vein is a central venous catheter, not peripheral. If the insertion site was peripheral, this would be coded as a PICC line insertion using code 36572 or 36573, depending on the patient’s age. Even though the provider called it a midline catheter insertion, the final catheter placement is the determining factor.
Q: Does this documentation describe a tunneled or non-tunneled device? It is our understanding that all devices require some “tunneling” but that a tunneled catheter has a cuff. We have disagreement among our coders as to which type of device this is.
The skin over the operative site was prepped using 2% chlorhexidine cutaneous antisepsis and draped with two large sterile sheets. Cap, mask, sterile gown, sterile gloves, and proper surgical hand hygiene were employed by all members of the treatment team. Using local anesthesia the vein was accessed with direct ultrasound control. Access was made through a subcutaneous tunnel, and the single lumen power injectable catheter was trimmed to the appropriate length. The catheter was passed through the tunnel and peelaway sheath, and then the peelaway sheath was removed and the catheter positioned appropriately. The catheter was sutured to the skin exit site and dressed.
A: The documentation is lacking in that the site of the venous access is not documented. Ideally, the physician would include documentation that a vein (e.g., jugular) was accessed and then include documentation of a second, counter incision site (e.g., in the chest). The documentation does suggest this was a tunneled device, but documentation of either the two access sites and/or placement of a catheter with a cuff would be solid evidence for coding a tunneled catheter. The key to code assignment is the distance between the vascular insertion site and where the catheter exits the skin. Typically the vascular insertion site is in the neck and the catheter is tunneled a great distance to exit the skin in the chest.
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Deanna Upston, CPMA, CPC, COSC
Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience. Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians. She has put together multiple education sessions for both provider and coder. She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software.