Health Information Management

Q&A: Coding for the insertion of a midline catheter by a nurse in an outpatient setting

JustCoding News: Outpatient, November 4, 2009

Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

QUESTION: How should we code the insertion of a midline catheter performed by a nurse in an outpatient setting? More specifically, how should we code this procedure when a nurse executes it in an ambulatory infusion center at a hospital?

ANSWER: The midline catheter is used in patients requiring several weeks of IV therapy. CPT guidelines direct you to code the catheter placement separately from the infusion therapy with the appropriate CPT code, as long as the physician was supervising (applying the “incident-to” rule*). CPT injection and infusion codes 96365–96379 are not meant to be used to report a physician service in a facility (i.e., hospital). Therefore, the fact that a nurse inserted the catheter is expected.

Depending on specific third-party payer rules, I would also recommend appending the appropriate modifier, such as -TD to report that a registered nurse provided the service or -TE to indicate that a licensed practical nurse/licensed vocational nurse provided the service.

* Reference: Medicare Benefit Policy Manual, chapter 15, revised August 7, subsection 60:

  • 60 - Services and Supplies Furnished Incident to a Physician’s/NPP’s Professional Service. Hospital services incident to physician’s or other practitioner’s services rendered to outpatients (including drugs and biologicals which are not usually self-administered by the patient), and partial hospitalization services incident to such services may also be covered. The hospital’s intermediary makes payment for these services under Part B to a hospital.
  • 60.1 - Incident To Physician’s Professional Services. Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness.
  • 60.2 - Services of Nonphysician Personnel Furnished Incident To Physician’s Services. A nonphysician practitioner such as a physician assistant or a nurse practitioner may be licensed under State law to perform a specific medical procedure and may be able (see §§190 or 200, respectively) to perform the procedure without physician supervision and have the service separately covered and paid for by Medicare as a physician assistant’s or nurse practitioner’s service.
  • 60.3 - Incident To Physician’s Services in Clinic (Rev. 1, 10-01-03) B3-2050.3. Services and supplies incident to a physician’s service in a physician directed clinic or group association are generally the same as those described above.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com

 This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Outpatient!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular