Health Information Management

New codes for CVA procedures

APCs Insider, January 28, 2004

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QUESTION: Could you give me some information about central venous access (CVA) procedures for 2004 and their APC impact? We are currently working with the chargemaster along with health information management (HIM) coding professionals to secure accurate coding of these procedures as well as complete documentation.

ANSWER:

For 2004, the American Medical Association introduced new codes for CVA procedures. Pay close attention to the new subsection "Central Venous Access Procedure," including CPT codes 36555 - 36597, with the following definitions:

  • Defines central venous access catheter or device
    --The tip of catheter/device must terminate in the subclavian, brachiocephalic (innominate) or iliac veins, superior vena cava (SVA) or inferior vena cava (IVA) or the right atrium
  • Defines central versus peripheral insertion
    --Central insertion occurs in the subclavian, internal jugular, femoral vein, or inferior vena cava
    --Peripheral insertion occurs in veins of the extremities to include cephalic and baslic vein

  • Defines five procedure categories to include insertion, repair, partial replacement, complete replacement, and removal

  • Defines same-day removal of old and placement of new central venous device

  • Provides cross reference for new imaging guidance codes: 76937, ultrasound guidance for vascular access and 75998, fluoroscopic guidance for central venous access device placement. Both codes are status indicator N, meaning a packaged service

    Note the APC payment difference between coding a centrally inserted tunneled (36561) v. a peripherally inserted (36571) CV catheter with subcutaneous port in patients five years or older. CPT code 36561, status indicator T, APC 0115, has a relative weight of 25.6437 and a payment of $1,399.15. And CPT code 36571, status indicator T, APC 0032, has a relative weight of 11.4907 and a payment of $626.94.

    Review this information along with your facility's documentation procedures with your HIM coding staff to assess educational needs for the coding staff and physicians. Do not forget to update your chargemaster in departments that provide this service, such as special procedure or interventional radiology departments. Consult your 2004 CPT manual for the full description of definitions and CPT codes.



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