2019 CPT® PICC Code Updates by the Numbers

Posted on 12 Dec, 2018 |comments_icon 0|By Bruce Pegg
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Your new 2019 CPT® manual contains a lot of changes to the peripherally inserted central venous catheter (PICC) codes and guidelines. But if you code for a provider who has received PICC certification, you don’t have to get overwhelmed. We’ve added up all the major 2019 CPT® code updates for you, including all the guidelines you need, to help make your PICC claims count in the New Year. A quick stroll through five key points will ensure your claims are clean and reimbursable.

1. The Number of New Entry Sites to Learn

CPT® revised the introduction to the central venous access procedures section to add a third peripheral insertion site for venous access. In addition to basilic and cephalic vein entry sites, you can now look for the saphenous vein as an entry site in your provider’s documentation.

2. The Number of New Codes to Use

You’ll find that CPT® has added two new image-guided PICC insertion codes that bundle together the insertion, guidance, documentation, and interpretation, as follows:

  • 36572 — Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; younger than 5 years of age
  • 36573 — … age 5 years or older.

But before you use them, read the updated CPT® coding guidelines 2019 in point four below to make sure you know exactly what kind of imaging they describe.

3. The Number of Revised Codes to Remember

Like the new codes, the revised codes also spell out the role of imaging guidance in the respective procedures. The revised text is in bold below for easy identification:

  • 36568 — Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age)
  • 36569 — … age 5 years or older
  • 36584 — Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement.

4. The Number of New Guidelines/Instructions to Memorize

Unsurprisingly, the first three clarify guidance issues, though the last one shouldn’t be overlooked:

  • The revisions to 36568-36569 and 36584, and the additions of 36572-36573, make guidance bundling issues much clearer. This means you cannot use 76937 (Ultrasound guidance for vascular access …) and 77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal …) with these new and revised codes.
  • A new instruction clarifies that you should use 36568-36569 for “PICCs placed using magnetic guidance or any other guidance modality that does not include imaging or imaging documentation.”
  • Another new guideline stipulates that “ultrasound guidance for PICC placement should include documentation of evaluation of the potential puncture sites, patency of the entry vein, and real-time ultrasound visualization of needle entry into the vein.”
  • And one more new instruction also reminds you that “‘midline’ catheters are not central venous access devices and you may not report one as a PICC service.” They should be reported with venipuncture codes 36400, 36405, 36406, or 36410.

5. The Number of Years for Age Cutoff

No, this hasn’t changed — it’s still set at under five years and over five years for each of the PICC code pairs. But it’s still a good idea to pay attention to the age parameters with the new pair of 36572 and 36573 as well as the centrally inserted catheter code pairs 36555/36556, 36557/36558, 36560/36561 and the peripherally inserted catheter code pairs 36568/36569 and 36570/36571.

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Author

Bruce Pegg
Editor, Newsletters

An experienced teacher and published author, Bruce is TCI’s new voice of primary care, delivering advice and insights every month for coders in the fields of family, internal, and pediatric medicine through Primary Care Coding Alert and Pediatric Coding Alert. Additionally, he is the current editor of E/M Coding Alert. Bruce has a Bachelor of Arts degree from Loughborough University in England and a Master of Arts degree from The College at Brockport, State University of New York. He recently became a Certified Professional Coder (CPC®), credentialed through AAPC.

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