Basics-Chest X ray Post Central Line Placement
We have already learned about the central line placement procedures. These procedures are commonly done for placing central venous catheters using temporary or permanent catheters. The code range varies for coding Tunneled and Non-Tunneled Central Venous Catheter (CVC) and Peripheral Central Venous Catheter (PICC) is from 36555-36571. In addition, we have to use guidance to place this central venous catheter in the exact position. Therefore, we know for taking access we are using ultrasound guidance (76937) code and for proper placement of catheter, we are using Fluoroscopic guidance (77001). Now, this is the short story about the central venous catheter along with the guidance codes. However, we are here to learn the complications of coding which start after placing the catheter. Here, we will discuss the procedure done after central line placement on same day or during global period.
Scenarios Chest X ray Post Central Line Placement
As we discussed above after correct placement of central venous catheter, the physician sometimes perform the chest x ray. This chest x ray post central line placement is mostly done to check whether the catheter is placed properly or not. Now here we will have three situations depending on the diagnosis.
Suppose the patient is having the same diagnosis as Central line placement, which is V58.81 (Z45.2) for central line placement (36555-36571) and for chest x ray (71010 or 71020) on same day. Now, here if we code chest X ray along with central line placement CPT Code, chest x ray may not be paid. The simple reason to explain is, chest X ray is normally done after central line placement to check the final position of catheter, and hence chest x ray exam is included with central line placement. So, please check the diagnosis before billing the chest x ray post-central line placement. The diagnosis should be either related or unrelated to original diagnosis but not the exact.
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Now, for this we should first understand the concept of global period. Now, global period is nothing but the duration in which any procedure performed during the postoperative period related to the original procedure. The procedures performed during global period needs to be billed using global period modifiers like 78 or 79, to bill the extra services performed during global period.
Global Period for CPT codes
36555, 36556, 36558, 36569 – 0 days
36557, 36558, 36560, 36561, 36563, 36565, 36566, 36571– 10 days
Now, the CPT codes with 0 (zero) global period days will not have any benefit. So, the procedure performed during postoperative period will also be billed with these CPT codes without any modifiers. Perfect example will the that if after placing a central venous catheter, chest x ray is performed next day, this will also be billed with central line placement cpt code. But if the Chest x ray is done immediately after post central line placement it becomes a part of Central Line Placement procedure, which is not billed separately. Non-tunneled catheter (36555 &36556) and PICC placement without subcutaneous port or pump (36568 & 36569) do not have global period.
On the contrary, for CPT codes with 10-day global period will have different story. Now, here we will consider that there is some complication with central venous catheter placed during or after original procedure. So, if there is some complication present with central line placement and the patient comes in postoperative period or global period with related diagnosis, the services provided for the treatment will be billed using 78 modifier. So, if after placing central venous catheter the patient has a mechanical complication of central venous catheter having icd 9 code 996.1, and has to perform chest x ray, then the chest x ray cpt code will have 78 modifier like 71010-78. So, finally if any procedure performed during global period with diagnosis related to original procedure will be appended with 78 modifier.
Now, suppose a patient comes with unrelated diagnosis during the global period. Now, here also we have to use a modifier to bypass the CCI edits. For example, patient having a central venous catheter placement (V58.81) and has to undergo a chest x ray for pleural effusion (511.9) during global period. Since, these diagnosis are completely unrelated with each other in global period we will use 79 modifier with the chest x ray like 71010-79 to bypass the edits. So, if any procedure performed during global period with diagnosis unrelated to original procedure will be appended with 79 modifier.
Hope, these scenarios help you in coding Chest X ray Post Central Line Placement in future. Do share the article if you liked it.