Insertion of Tunneled Catheter

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Insertion of Tunneled Catheter
ASDIN Coding University
1
Primary & Secondary
• As with other procedures there are primary codes
that are used in virtually every tunneled catheter
placement procedure and secondary codes for
procedures that are used only when exceptional
events occur
• We shall consider these separately
2
Primary Codes
Used in virtually every TDC placement procedure
3
Ultrasound Guidance
• The code for ultrasound guided cannulation when
inserting a tunneled catheter is +76937
• The descriptor for this code is - ultrasound guidance
for vascular access requiring ultrasound evaluation
of potential access sites, documentation of selected
vessel patency, concurrent realtime ultrasound
visualization of vascular needle entry, with
permanent recording and reporting
4
Requirements for Code Usage
• As indicated in the descriptor, use of +76937
requires that an image be recorded and made part
of the permanent record
• As the descriptor states, this requires concurrent
realtime ultrasound visualization of the vascular
needle entry
• Additionally, the record should include a narrative
documented description of the localization process
for which the guidance was utilized
5
Restrictions for Code Usage
• +76937 code should not be used in cases where the
vein is only examined by ultrasound and the
cannulation is not actually ultrasound guided (realtime)
• +76937 is an add-on code and requires that the
primary procedure also be listed, in this case that
would be 36558 for catheter insertion
6
Fluoroscopic Guidance
• The code for fluoroscopic guidance used in connection
with the placement of a central venous device is +77001
• The descriptor for this code is - fluoroscopic guidance
for central venous access device placement,
replacement (catheter only or complete), or removal
(includes fluoroscopic guidance for vascular access and
catheter manipulation, any necessary contrast injections
through access site or catheter with related venography
radiologic supervision and interpretation, and radiologic
documentation of final catheter position)
7
Code Includes Angiographic Studies
• As indicated, +77001 also includes any necessary
contrast injections through the access site or catheter
with related venography radiologic supervision and
interpretation, and radiographic documentation of the
final catheter position
• It is possible to have an angiographic study qualify as a
separate procedure if it is done by selective
catheterization or if it is done from a separate access
site
• In such an instance, a 59 modifier should be attached to
the code to indicate that it is a separate procedure
8
Add-On Code
• The code +77001 is an add-on code and requires
that the primary procedure also be listed, which
would be 36558 the code for catheter insertion
• The code +77001 cannot be used with 77002 which
is the code for using a target device for cannulation
9
Catheter Insertion
• The code used for the actual catheter insertion is
36558
• The descriptor for 36558 is – insertion of tunneled
centrally inserted central venous catheter, without
subcutaneous port or pump, over 5 years of age
• This code is for the procedure in which a single
tunneled catheter is inserted
10
Double Catheter
• If two structurally separate catheters are inserted into
two separate venous sites, the appropriate code would
be 36565
• The descriptor for this code is - insertion of tunneled
centrally inserted central venous access device,
requiring two catheters via two separate venous access
sites, without subcutaneous port or pump
• The descriptor indicates that if 36565 is to be used, the
two catheters must be inserted via separate access sites
• A dual catheter inserted through a single venous access
site would not qualify
11
Secondary Codes
Used when an unusual circumstances arises
12
Fluoroscopic Guidance for Needle Placement
• In some instances the internal jugular vein cannot be
cannulated directly and a device such as an
angioplasty balloon or a snare might be inserted and
used as a target for cannulation with fluoroscopic
guidance for the cannulation needle placement
• The recommended code for this procedure is 77002
• The descriptor for this code is - fluoroscopic
guidance for needle placement (e.g., biopsy,
aspiration, injection, localization device)
13
77002 Includes Angiography
• 77002 also includes any necessary contrast injections
through the access site or catheter with related
venography radiologic supervision and interpretation,
and radiographic documentation of the final catheter
position
• It is possible to have an angiographic study qualify as a
separate procedure if it is done by selective
catheterization or if it is done from a separate access
site
• In such an instance, a 59 modifier should be attached to
the code to indicate that it is a separate procedure
14
77002 Restrictions
• The code 77002 is not an add-on code
• It is a column 2 code to 36558 (catheter insertion)
• It can be used with 36558 but does require a
modifier, in the instance described here, a 59
modifier would be appropriate
• It is a column 1 code to +77001 and the two are
mutually exclusive (can’t be used together)
15
Venous Angioplasty
• If a significant stenosis is encountered when a tunneled
catheter is being placed and is treated with angioplasty, then
the appropriate codes for that procedure should be recorded
• The code for venous angioplasty is 35476, its descriptor is –
transluminal balloon angioplasty, venous
• Code 75978 describes the radiological supervision and
interpretation, its descriptor is - transluminal balloon
angioplasty, venous, radiological supervision and
interpretation
• If a venous angioplasty is performed, then the use of +77001
(or 77002) will require a 59 modifier since this would combine
the use of a diagnostic and a therapeutic RS&I code
16
Aborted Cannulation Site
• If, after cannulating and examining a vein
angiographically, it is decided to abandon that site and
move to another, additional codes may be warranted to
account for the work that was done
• At the aborted site this often includes:
– Ultrasound guidance for cannulation
– Cannulation
– Fluoroscopy and angiography
• These procedures are coded differently since a catheter
is not inserted at the aborted site
17
Ultrasound Guidance for Cannulation
• The recommended code for ultrasound guided cannulation of
an aborted site is +76937
• The descriptor for this code is – ultrasound guidance for
vascular access requiring ultrasound evaluation of potential
access sites, documentation of selected vessel patency,
concurrent realtime ultrasound visualization of vascular
needle entry, with permanent recording and reporting
• This is an add-on code and must be used with a primary code,
in this instance that code would be 36410 (next slide)
• Image documentation in the medical record is required
18
Cannulation of Aborted Site
• Unlike the usual situation, the ultrasound guidance
code, +76937, does not include the cannulation
• The code 36410 is recommended for cannulation of
an aborted site
• The descriptor for this code is - venipuncture, age 3
years or older, necessitating physician's skill
(separate procedure), for diagnostic or therapeutic
purposes (not to be used for routine venipuncture)
19
Fluoroscopic Guidance With Aborted Site
• The use of the code + 77001 can be used only for the
site that is actually used to insert the catheter
• With an aborted site, the coding of the fluoroscopy
and angiography is dependent upon the specific
vessel involved
20
Angiogram of Aborted Site
• The internal jugular vein is often involved with an aborted site
• If this is the case and an angiogram of that vein was performed,
then the code 75860 would be warranted
• The descriptor for 75860 is - venography, venous sinus (e.g.,
petrosal and inferior sagittal) or jugular, catheter, radiological
supervision and interpretation
• Additional codes might be warranted if additional veins are
involved
• When the code 75860 is used with 36410, it is a column 1 code and
36410 is a column 2. In this instance, while the two can be used
together, the column 2 code, 36410, would require a 59 modifier
• The medical necessity for these procedures should be clearly
documented in the patient record and in the recorded images
21
Important Note
• This document is for informational purposes only and
should serve as a guideline for appropriate coding.
• The ultimate responsibility for correct coding
/documentation remains with the provider of service.
• ASDIN makes no representation, warranty, or guarantee
that this compilation of information is error-free, nor
that the use of this guide will prevent differences of
opinion or disputes with CMS or any other carrier.
• ASDIN will bear no responsibility or liability for the
results or consequences that may grow out of the use of
this guidance.
22
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