Basics of CPT code 36000 & 36010

We have learnt everything about catheterization of arteries. The same concept of selective and non-selective catheterization is followed in studying veins as well. If you know the rules for coding catheterization, same follows here also. The main two points which you should always remember while coding selective and non-selective catheter placement are the starting point or the puncture site for taking access and the location of the final catheter placement in each vessel or vascular family accessed. The below two procedure codes are also used when there is a direct introduction of needle or catheter in vein.

A venous “vascular family” is similar to an arterial family but the common base structures are the vena cava or portal vein. Venous families are named after the vessel that ultimately drains into the inferior vena cava, superior vena cava, or main portal vein. All branches of this “parent” vessel are members of the family. To simplify coding and prevent confusion about unnamed venous vessels, coding extends only up to the second-order branch, for example, left renal vein (first order), left inferior phrenic vein (second order). Named or unnamed branches beyond a second-order venous branch should be reported with the second-order venous branch code (36012)

36000- Introduction of needle or intracatheter, vein

36010- introduction of catheter, superior or inferior vena cava

CPT code 36000 is integral to all nuclear medicine procedures requiring injection of a radiopharmaceutical into a vein. CPT code 36000 is not separately reportable with these types of nuclear medicine procedures. However, CPT code 36000 may be reported alone if the only service provided is the introduction of a needle into a vein.

Similarly Intravenous access (e.g., CPT codes 36000, 36400, 36410) is not separately reportable when performed with many types of  procedures (e.g., surgical procedures, anesthesia procedures, radiological procedures requiring intravenous contrast, nuclear medicine procedures requiring intravenous radiopharmaceutical.

Introduction of catheter into superior or inferior vena cava is reported with CPT code 36010. CPT code 36010 is equivalent to code 36200 when perfromed on arteries. When the catheter is in the superior or inferior vena cava it is non-selective, but when it entering into the first branch (eg, renal vein, jugular vein) or second order branch vein, then it is considered as selective catherization of veins. The selective code always supersedes the non-selective code.  Hence, all the first (CPT code 36011) and second order or higher (CPT code 36012) branch codes for veins will always include the non-selective code 36010, when performed through same access.

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When to use CPT code 36000 and 36050

For CPT 36000, the provider places a needle or a catheter through a puncture in the skin and into a peripheral vein. In CPT code 36002, the physician or other qualified health care provider injects a pseudoaneurysm, which is a pulsatile hematoma with a fibrous capsule that maintains persistent communication with the adjacent vessel. The vessel wall does not heal and blood flows back and forth between the vessel and hematoma during the cardiac cycle. Under ultrasound control, the physician advances a 22-gauge needle into the lumen of the pseudoaneurysm and injects thrombin to cause thrombosis of the pseudoaneurysm. In CPT code 36005, an opaque substance is injected through the catheter for venography. Once the procedure is complete, the catheter is removed and pressure is applied to stop bleeding at the injection site.

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When to use CPT code 36010

For CPT code 36010, the physician punctures a distal vein (typically antecubital, internal jugular, subclavian, or femoral) with a large needle and passes a guidewire via the needle into the punctured vein. The physician removes the needle while leaving the guidewire in place, and enlarges the skin opening slightly with a blade. The physician may slide an introducer sheath over the guidewire into the venous lumen, or may slide the catheter directly into the venous lumen without using an introducer sheath. If using an introducer sheath, the physician inserts the catheter into the vein through an O-ring in the introducer sheath (this prevents blood from leaking around the catheter) into the superior or inferior vena cava. The physician may check the catheter position with fluoroscope or with an x-ray.

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When to use CPT code 36011 & 36012

Through a puncture through the skin, the physician passes a needle into the vein and threads a guidewire through the needle into the vein. The needle is removed and the wire is passed to the desired location in the venous system. A catheter follows the wire into the selected point in the vein and the wire is removed. A first order branch from the vena cava (CPT code 36011) is any initial vessel draining directly into the vena cava (e.g., renal vein or jugular vein). A second order branch of the vena cava (CPT code 36012) is any vein draining into a first order branch (e.g., left adrenal, petrosal sinus). Contrast material for venography is injected into the catheter that has traveled to an area upstream of the site under investigation. Once the procedure is complete, the catheter is removed, and pressure applied to stop bleeding at the injection site.

So, as mention earlier the starting point or the puncture site and the final location of the tip of catheter needs to find out. Access for venous procedures is gained by several methods. Mostly the access point is via femoral vein or the internal jugular vein, like in CVC or PICC coding. In both arterial and venous, coding is based upon the starting and ending point of the catheter. Arterial selective codes provide four options to choose from (36215-36218 or 36245-36248); however, selective venous options are defined by only two coding choices- 36011 and 36012.

36011- Selective catheter placement, venous system, first order branch

36012- Selective catheter placement, venous system, second order or more selective, branch

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How to differentiate Selective and Non- selective catheterization

In venous coding, placement of catheter in Superior or Inferior vena cava is considered as Non-selective catheterization, just like in arteries the placement of catheter in aorta is considered as non-selective. Once, the catheter moves out of SVC or IVC, then it enters into the selective catheterization zones. In venous coding, the highest order is second order. So, the coding is less complicated, compared to arteries. There are only two selective option or choices.  Any access following catheter placement into a primary branch of superior vena cava (SVC) and inferior vena cava (IVC) (such as renal veins) or any secondary branch of the primary branch of a vessel would be defined by CPT code 36011. Any branch of vessel beyond the first order of selectivity will be defined by the second order CPT code 36012, which should be used for each second order vessel and beyond per separate branch of each vascular family studied.

Supply & Equipment codes used with CPT codes 36000-36012

SD148 catheter, (SIM2F1)
SD172 guidewire, cerebral (Bentson)
SF007 blade, surgical (Bard-Parker)
SG009 applicator, sponge-tipped
SG055 gauze, sterile 4in x 4in
SG074 steri-strip (6 strip uou)
SG079 tape, surgical paper 1in (Micropore)
SH039 heparin 1,000 units-ml inj
SH047 lidocaine 1%-2% inj (Xylocaine)
SH065 sodium chloride 0.9% flush syringe
SJ041 povidone soln (Betadine)
SA048 pack, minimum multi-specialty visit
SA067 tray, shave prep
SA071 kit, AccuStick II Introducer System with RO Marker
SB001 cap, surgical
SB009 drape, sterile, femoral
SB019 drape-towel, sterile 18in x 26in
SB024 gloves, sterile
SB028 gown, surgical, sterile
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SB044 underpad 2ft x 3ft (Chux)
SC008 catheter, angiographic, pig-tail
SC010 closed flush system, angiography
SC058 syringe w-needle, OSHA compliant (SafetyGlide)
SD089 guidewire, hydrophilic

EF019 stretcher chair
EL011 room, angiography
EQ168 light, exam