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Central Venous Access Procedures

To qualify as a central venous access catheter or device, the tip of the catheter/device must terminate in the subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena cava, or the right atrium. The device can be centrally inserted or peripherally inserted (PICC). The device may have an exposed catheter external to the skin (partially implanted) or via a subcutaneous port or pump (completely implanted).

You may see the term vascular access device or VAD for these devices. Devices can be non-tunneled or tunneled. A non-tunneled catheter has an exit point very close to where the catheter was inserted. A non-tunneled central venous device could be inserted in the emergency department. The creation of a tunnel is a specific and separate surgical step and not a simple skin incision with a dilation of a tract. The procedure is generally performed in the operating room. The length of the subcutaneous portion of the tunneled device is much greater. An example would be a hickman or groshong catheter. A device with a port must be tunneled and requires surgical creation of a skin pocket for the port. The port is completely implanted; there is no exit site from the skin. Examples include mediport and portacath. Don’t rely on brand names for these catheters as some can be used as a tunneled or non-tunneled catheter. A PICC line is inserted peripherally rather than inserted in a central vein.  PICC lines can be inserted by nurses at bedside rather than in an OR setting.

Non-tunneled central venous device 36555 - 36556

Tunneled central venous device 36557 - 36558

Completely implanted vascular access device (VAD) 36560 - 36563

Peripherally inserted central venous catheter (PICC) 36568 - 36571 

Coding Tips

  • Use 96522 for refiling or maintenance of implantable pump or reservoir

  • Do not charge separately for blood draw from port (36591), blood draw from central or peripheral line (36592) or irrigation (96523) at the time of insertion or with any other service

  • Do not use 36589 or 36590 for removal of non-tunneled device (includes PICC).

  • If an existing device is removed and a new one placed via a separate venous access site, appropriate codes for both procedures (removal of old, if code exists, and insertion of new device) should be reported.

  • Use 36593 for declotting by thrombolytic agent of implanted vascular access device or catheter. This would include a partially or completed implanted device. Do not charge drug administration codes separately with this service. Do not use this code for heparin flush. 36593 can be reported more than once if patient leaves and returns. Do not report multiple times for sequential administration of thrombolytic in a single session.
Disclaimer: All articles intended for general guidance only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.

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Comments (2) Comments
Comment By Laine Bridges - Thu, Dec 2nd, 2010 1:40 AM
Oliver we have created an article entitled PICC Line Removal to answer your question
Comment By Oliver J. Bourgeois - Wed, Dec 1st, 2010 10:02 PM
I see what not to use to report PICC line removal (non-tunneled). What do you report?E/M?
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