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CPT Code Validation for Midlines

There have been some questions regarding appropriate reimbursement coding for Midline catheters. PICC Excellence removed Midline CPT Code information pending the validation of this information. It now appears midline catheters will continue to use the same PICC codes for percutaneous insertion location even though the terminal tip of the catheter does not enter the central vasculature as you can see in the response below.   Based on a communication inquiry with CMS for CPT code validation, here is the response:   From a CPT coding perspective and based solely upon the information provided in your inquiry, the recommended to report codes 36568, Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under 5 years of age, or 36569, Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older, for PICC insertion for midline placement has not changed.  As stated in CPT Changes 2004 when the codes were created, “To qualify as a central venous access catheter or device, the tip of the catheter/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 either centrally inserted (jugular, subclavian, femoral vein or inferior vena cava catheter entry site) or peripherally inserted (eg, basilic or cephalic vein). The device may be accessed for use either via exposed catheter (external to the skin), via a subcutaneous port or via a subcutaneous pump.”  These guidelines and the reporting of PICC insertion codes for midline placement are still in place.   Following is the Relative Value Scale (RVS) Update Committee’s (RUC) rationale for classifying these codes.   History:  In the second, Five-Year Review of the RBRVS, CPT code 36489 Placement of central venous catheter (subclavian, jugular, or other vein) (eg, for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy); percutaneous over age 2 was increased from 1.22 to 2.50 work relative value units, as a rank order anomaly existed between this service and CPT code 36010 Introduction of catheter, superior or inferior vena cava (work RVU = 2.43).  In addition, a number of other services in the family were identified as potentially mis-valued.  CPT codes 36533, 36534, and 36535, which described the insertion, revision, and removal of implantable venous access device, and/or subcutaneous reservoir were considered by the RUC, but the RUC noted that the descriptor stated "and/or subcutaneous reservoir."  The RUC stated that there are multiple venous access capabilities for varying disease processes which require varying degrees of work for different venous access devices.  Therefore, the RUC agreed to refer this issue to CPT to create specific codes that are more descriptive of the actual service being performed.   The CPT Editorial Panel created a Central Venous Access Procedures Workgroup, who worked on this issue for nearly two years.  The results of their efforts are a section in CPT for Central Venous Access Procedures that describes these services in five categories:  

  1. Insertion (placement of catheter through a newly established venous access)
  2. Repair (fixing device without replacement of either catheter or port/pump, other than pharmacologic or mechanical correction of intracatheter or pericatheter occlusion (see 36535 or 36536 for those procedures – catheter clearance)
  3. Partial replacement of only the catheter component associated with a port/pump device, but not entire device.
  4. Complete replacement of entire device via same venous access site (complete exchange).
  5. Removal of entire device.
  Work Relative Value Recommendations   Five specialties participated in a survey of the physician work involved in this family of services, i

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