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.
Recent updates to the Health Insurance Portability and Accountability Act (HIPAA) represent the most significant shift in healthcare privacy and security requirements in over a
It is a bummer when you get hoisted on the petard of intellectual inconsistency. Whether it is different medical professionals with different approaches to a
Please log in to your account to comment on this article.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Stacey Shillito, CDIP, CPMA, CCS, CCS‑P, CPEDC, COPC. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
