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Is your facility’s CVA coding up-to-date?

HCPro Coder Connection, May 18, 2005

Is your facility's CVA coding up-to-date?

During 2001 and 2003, insertion of a central venous access (CVA) device - regardless of central v. peripheral access with port implantation - was coded 36533 and fell into APC 0115.

In 2004, the procedures section of the CPT Manual was reassembled to provide overall coding cohesiveness. Review the new subsection under cardiovascular, CPT code range 36555-36597. Then read the following operative report and select the correct codes.

Operative report
Preoperative diagnosis:
Prostate cancer
Postoperative diagnosis: Same
Anesthesia: Local with MAC
Operation: Mediport Catheter Placement

Procedure:
Patient is a 67-year-old male with prostate cancer, PSA levels increased, running out of venous access, in need of venous port. Operation is a placement of a Mediport Catheter.

With the patient in the supine position after intravenous sedation, the patient is prepped and draped in the usual sterile fashion. Local anesthetic 1% Xylocaine with 0.5% Sensorcaine is injected into the skin and subcutaneous tissues in the subclavian area.

An 18-gauge needle is inserted into the subclavian vein on the first pass with ease. A wire is advanced and the localizing needle removed. X-ray is used as a control using fluoroscopy (75998) to ensure the wire is indeed in good position in the superior vena cava, which it is.

Additional local anesthetic is injected into the skin and subcutaneous tissues and the left chest wall, and a subcutaneous pocket, as well a tract from the skin wound to the pocket, are made. The catheter is cut to an appropriate size. The catheter is run through the subcutaneous tunnel and attached to the port itself (36561).

At this time, the port is sutured into position using 3-0 interrupted Prolene sutures. The breakaway catheter is removed, and the catheter flushed with heparin saline 10 units per cc with excellent blood return and flushing easily. The wounds are closed with 3-0 vicryl, in the subcutaneous tissues 4-0 intracuticular Monocryl, and dressings applied. The catheter is flushed with three cc of 1,000 units of heparin per cc, dressings applied, and patient is transferred to recovery in satisfactory condition.

The coding: ICD-9-CM diagnosis code 185 (malignant neoplasm of prostate), HCPCS codes C1751 (catheter, inf. per/cent/midline), C1788 (port. indwelling, imp.), CPT codes 75998 (fluroscopic guidance for vein. device), 36561 (insert tunneled cy cath).

Comments: Refer to the operative report: the subclavian vein was accessed (central insertion) and under fluoroscopy, advanced to the superior vena cava (definition and position criteria met per CPT manual). Next, subcutaneous pocket was created to house the port and a subcutaneous tunnel was created to connect port and catheter.

Editor's note: This article was excerpted from HCPro, Inc.'s new book, Guide to APC Auditing to Achieve Revenue Integrity, written by Andrea Clark, RHIA, CCS, CPCH. For more information or to order, go to www.hcmarketplace.com or call 877/727-1728.

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