Central venous access and PICC line placements were a bit of a headache for coding this year due to new codes, language and guidelines that went into effect in January.
For patients requiring longer term access than provided by a regular IV, or when smaller veins typically used for an IV can’t be accessed, central venous access catheters may be placed. These access catheters may be inserted in a central site (i.e., jugular, subclavian, femoral vein or inferior vena cava) or peripherally (i.e., basilic, cephalic or saphenous vein). Peripherally inserted central catheters are commonly referred to as PICC lines.
Regardless of where the catheter is inserted from, to qualify as a central venous access the tip of the catheter must end up in one of the following locations:
If the catheter ends anywhere outside one of the six sites listed above, it is not a central venous catheter. Instead, it is considered a midline catheter. In prior years, even if the catheter ended up outside of one of those locations, if the intent was a PICC line placement coding as such with a 52 modifier was appropriate. In 2019, when the new PICC line placement codes (36572, 36573) were introduced, CPT® also issued a clarification regarding what determines a central venous catheter vs. a midline catheter:
“Midline catheters by definition terminate in the peripheral venous system. They are not central venous access devices and may not be reported as a PICC service. Midline catheter placement may be reported with 36400, 36405, 36406 or 36410.”
This change negates instructions previously used for years. For IR departments this means that it is critical to know where the catheter ended up in order to code the service properly – code based on what was done vs. intent.
In addition to the central vs. midline clarification released last year, CPT also introduced the two new codes referenced above for PICC line placement. These codes now include “all imaging guidance, image documentation and all associated radiological supervision and interpretation required to perform the insertion.”
This definition clearly bundles any imaging guidance used for the initial venous access, but one of the primary questions asked throughout the year has been what about chest x-rays performed as part of the catheter placement? These chest x-rays are generally done to confirm placement and were in the past separately reported. However, when we look closely at the code descriptions, they state including all imaging guidance. All imaging guidance in this case includes the chest x-rays for final confirmation of placement and “71045, 71046, 71047, 71048 should not be reported for the purpose of documenting the final catheter position on the same date of service” as placement.
Healthcare reimbursement operates on a fascinating paradox: physician services aren’t paid based on market rates or simple invoices, but on calculated values derived from estimated
A Monitor Monday listener recently sent word of what can only be described as a deeply troubling denial of a gender reassignment surgery. The listener
Please log in to your account to comment on this article.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
