Deborah Grider, CPC, CPC-P, CPC-I, COC, CPMA, CEMC, CCS-P, CDIP
Central venous access procedures, commonly performed in critical care, have undergone a change in CPT 2019. To qualify as a central venous catheter or device, the tip of the catheter or device must terminate in the subclavian, brachiocephalic (innominate), or iliac veins; the superior or inferior vena cava; or the right atrium.
The venous access device may be inserted centrally (into the jugular vein, subclavian vein, femoral vein, or inferior vena cava), or peripherally (eg, into the basilic or cephalic vein). Midline catheters terminate in the peripheral venous system and are not considered central venous catheters, so they cannot be reported as peripherally inserted central catheters (PICCs). Central venous catheter insertion is bundled under pediatric codes 99468, 99469, 99471, 99472, 99475, and 99476, while PICC insertion is not bundled for patients of any age.
Two CPT codes were revised: 36568 and 36569. An instructional note was added to not report these two codes with CPT 76937 (ultrasonic guidance) or 77001 (fluoroscopic guidance). In addition, an instruction was added to report a PICC insertion with imaging guidance without a port or pump report, using CPT codes 36572 or 36573, depending on patient’s age. PICCs placed using magnetic resonance guidance or any other guidance that does not include imaging or image documentation is reported using 36568 or 35569, depending on patient’s age.
- 36568: Insertion of PICC without subcutaneous port or pump without imaging guidance; age younger than 5 years
- 36569: Insertion of PICC without subcutaneous port or pump without imaging guidance; age 5 years and older
Two new CPT codes were added to report PICC insertion based on patient’s age without a subcutaneous port or pump.
- 36572: Insertion of PICC without subcutaneous port or pump, including all imaging guidance and documentation and all associated radiologic supervision and interpretation to perform the insertion; age younger than 5 years
- 36573: Insertion of PICC without subcutaneous port or pump, including all imaging guidance and documentation and all associated radiologic supervision and interpretation to perform the insertion; age 5 years and older
These two new codes have 0 global days based on the 2019 Centers for Medicare and Medicaid Services physician fee schedule database.
CPT code 36584, for a complete replacement of a PICC without subcutaneous port or pump was revised to include all imaging guidance and documentation and all radiologic supervision and interpretation. This code is not age specific; it can be used for all patients, regardless of age. New instructions also say that, when imaging guidance is not used to perform the procedure, the unlisted code 33799 should be reported.
- 36584: Complete replacement of a PICC without subcutaneous port or pump, through same venous access, including all imaging guidance and documentation and all associated radiologic supervision and interpretation required to perform the replacement
New instructions say that CPT codes 36572, 36573, and 36584 cannot be reported with code 76937 (ultrasonic guidance) or 77001 (fluoroscopic guidance). Imaging cannot be reported to confirm the final catheter position or to confirm location of the catheter tip. If imaging is not performed by the practitioner performing the PICC insertion or replacement, CPT instructs the use of Modifier 52 to reflect the reduction of the service. The instructions also say that CPT codes 71045-71048 (chest radiographs) should not be reported to verify the final catheter position.
Imaging guidance for PICC placement includes:
- All imaging necessary to complete the procedure
- Image documentation that includes images from all modalities stored in the patient’s medical record
- Radiologic supervision and interpretation
- Venography performed through the same venous puncture
- Documentation of final central position of the catheter with imaging
Ultrasound guidance for PICC placement includes:
- Documentation of the potential puncture site(s)
- Patency of the entry vein
- Real-time ultrasound visualization of the needle entry into the vein
It is important to select the PICC codes based on the patient’s age and the imaging performed. Providers should ensure that, when imaging or ultrasound guidance is performed, the appropriate documentation is evident in the patient’s medical record.
Sources: American Medical Association. CPT Professional. Chicago, IL: American Medical Association; 2019.
American Medical Association. CPT Changes. Chicago, IL: American Medical Association; 2019.
Centers for Medicare and Medicaid Services. Physician Fee Schedule. January 2019 release. Washington, DC: Centers for Medicare and Medicaid Services. https://go.cms.gov/2CQxHxC. Accessed January 8, 2019.