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How to code PICC line declotting

APCs Weekly Monitor, September 3, 2004

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QUESTION: What would be the correct CPT code for a patient that comes in to have his or her peripherally inserted central venous catheter (PICC) line declotted? This is done by a nurse using Activase injected directly into the line. The patient is taken to the treatment room for whatever time is required for the procedure and charged accordingly.

ANSWER: A clotted PICC line can be relieved by injecting Cathoflo Activase or alteplase recombinant, 1 mg (HCPCS code J2997), directly into the line. This substance dissolves fibrin (a substance that causes blood to clot), breaking down the thrombus and restoring function.

In current CPT and HCPCS manuals, there is no detailed code to reflect this procedure. Therefore, report the appropriate E/M service, i.e., new patient 99201 through 99205 or established patient 99211 through 99215, to reflect the appropriate hospital resources based upon your facility mapping criteria.

In addition, HCPCS code J2997 is a detailed payable drug under OPPS, and must be reported with revenue code 636 along with the appropriate unit reporting based on the narrative of the HCPCS code and documented dosage.

Remember, if the line flushing (e.g., saline or heparin) is considered part of a routine same-day chemotherapy or infusion therapy service, do not report it separately.

For more information on port flush, see page 59861 of November 30, 2001 OPPS Final Rule.

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