Health Information Management

Q/A: Charging for PICC line insertion radiologic guidance

APCs Insider, July 15, 2011

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Q: We have been told that we may not charge for radiology chest one view or two views (CPT® codes 71010, 71020) when performed with the percutaneous insertion of a central catheter (PICC) placements. We created this radiology charge to ensure correct placement and position of the catheter. Our hospitals can perform up to 15 chest x-rays daily for outpatient PICC placements. How can we capture and charge for these resources?

A: The most current information available from the National Correct Coding Initiative Coding Policy Manual for Medicare Services states:

When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. The chest radiologic examination is integral to the procedure, and a chest radiologic examination (e.g., CPT codes 71010, 71020) should not be reported separately.

Based on this instruction, review the following CPT codes:

  • Central venous catheter insertion (36555–36571, 36578–36585)
  • Fluoroscopic guidance (77001)

Regardless of whether fluoroscopy is performed during PICC line insertion, you may not charge for the initial chest imaging film that ensures correct placement as a separate line item with modifier -59 (distinct procedural service). This is a screening exam for placement and is not diagnostic.
Hospitals should build the cost of the imaging into the overall charge for the procedure to ensure they capture the use of resources and are submitting appropriate charges for future APC rate setting.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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