Health Information Management

2004 central-access device codes

APCs Insider, March 19, 2004

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QUESTION: We are reviewing the 2004 central-access device codes and need clarification regarding the reporting requirements for removal of a tunneled central venous access device without a port or pump or CPT code 36589. Any ideas?

ANSWER: A tunneled central-venous access device does not directly enter a vein at the location where it is inserted. Instead, it is tunneled under the skin to enter a vein at another location or a subcutaneous tunnel must be created from the anterior chest wall to the venotomy site and the catheter is passed through the tunnel.

Removal of a tunneled central-venous access catheter (CPT code 36589) is a surgical procedure where the subcutaneous tunnel is entered by cutdown and blunt dissection to remove the catheter from the previous placed tunnel. Hemostasis is established with manual pressure and the wound is closed and dressed in the standard fashion.

Nontunneled catheters and peripherally inserted central catheter (PICC) lines may be removed by clinicians within your institutions based upon the facility's policy and state regulations. Typically, this is referred to as a removal with "strong pull." After catheter removal, the clinician applies digital pressure at the site for 10 to 15 minutes, depending on the size of the catheter, and then covers the site with sterile gauze and tape. Do not report CPT code 36589 or 37799 for removal of nontunneled catheters or PICC lines. CPT Changes 2004: An Insiders View states, "The work required for removal of a nontunneled central venous access catheter is considered to be inherent in the E/M visit which it is performed." If the patient's visit is for the sole purpose of catheter removal, it is appropriate to bill an E/M visit code.

We recommend that your facility work with your physicians and clinicians regarding the appropriate documentation to support the new requirements for 2004 central venous access devices.

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