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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.