Central Venous Access procedure - Guidelines

Central Venous Access procedure:

            Inserting a catheter into a blood vessel to deliver medication or draw blood from a patient’s body, Central venous access procedure is performed for those who required long term medications.

           To understand these procedures we need to watch the entry site and terminating site of the catheter.

A. Entry Site:

1.   Centrally inserted

                         - Jugular, subclavian, femoral vein (or) IVC

2.   Peripherally inserted

                        - Basilic (or) cephalic vein or saphenous vein.

 

B. Terminating site (catheter tip position)

      -  Subclavian, brachiocephalic, iliac vein, SVC / IVC or at the right atrium.

           

The device may be accessed via,

1.     Exposed catheter (external to the skin)

2.     Subcutaneous port

3.     Subcutaneous pump

 

There are five main categories,

1)   Insertion

2)   Repair

3)   Partial replacement  (Only catheter component)

4)   Complete replacement (Entire device)

5)   Removal.

 

Insertion: Placement of catheter through a newly created venous access.

CPT Codes 36555 - 36571

These codes are divided based on

                -         Age of the patient

                -         Central or Peripheral

 

  Centrally inserted catheters codes are arranged like, 

      - Non tunneled  (36555, 36556)

      - Tunneled (36557, 36558)

      - Port (36560, 36561)

      - Pump (36563)

  Peripherally inserted catheters codes are arranged like,

      - without imaging guidance (36568, 36569)

      - with imaging guidance (36572, 36573)

      - with port (36570, 36571)

 

For Repair / Replacement / Removal 

     -  Look for Central or peripheral inserted catheter

     -  Look for Tunneled or non-tunneled

     -  Look for with or without port / pump

 To check the catheter using contrast:

         - CPT 36598 (Including the guidance)

Coding guidelines:

If an existing device is removed and a new one is placed via a separate venous access site

         - Code both (Removal of old and insertion of new)

If imaging guidance is used for gaining access and manipulating the catheter into final position.

        - Use 76937 and 77001 (can code both if performed)

Chest X-ray for the purpose of the final catheter position on the same day of service should not be coded with 36572, 36573, 36584. if catheter tip location is not confirmed – add mod 52 with 36572, 36573, 36584. 

Midline catheters are not central venous access device - Use 36400, 36406 or 36410

PICC placed using MRI or any guidance that does not include image documentation are reported with CPT 36568 / 36569.

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