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Clear 1 Line for Accurate Swan-Ganz Coding by Gau Gan

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Clear 1 Line for Accurate Swan-Ganz Coding by
Article Posted: 06/04/2012
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Clear 1 Line for Accurate Swan-Ganz Coding

Reporting one placement will avoid inappropriate double billing of 93503.

The global anesthesia codes involve a lot of services, but when your anesthesiologist places a Swan-Ganz catheter, you’ll require knowing when you should -- and shouldn’t -- report CPT code 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) separately. Follow these expert tips to make certain your catheter coding is spot-on.

Don’t Assume Every CVP Uses Swan-Ganz

While your anesthesiologist is involved in an extensive heart procedure, he probably places a central venous pressure (CVP) catheter. The line is most frequently placed in the patient’s superior vena cava, and may be used for further purposes, including IV fluid delivery, for adjusting the patient’s blood volume, or for central drug infusion.

Furthermore, your anesthesiologist may place a Swan-Ganz catheter (SGC), also termed as a pulmonary artery (PA) catheter. This catheter can monitor pulmonary artery pressure, besides measure cardiac output and other cardiovascular functions. Swan-Ganz is for definite monitoring and central access.The SGC has multiple ports for central circulation access, including an regional anesthesia (RA) port, PA port, CVP port, and perhaps the main line or “introducer."

What it means to coding: In case documentation demonstrates that your anesthesiologist placed a PA catheter, you’ll report CPT code 93503, along with the suitable anesthesia code.

Reason: Once an anesthesiologist places an SGC line, he runs it through the CVP line. So while the CVP line is inserted as part of the procedure of inserting an SGC, the CVP line is then considered a component of the line placement, and is not reimbursable. Only the Swan-Ganz line is reimbursable.

Modifier 59 Use Is Possible

There are many cases where the physician will use both CVP line and a Swan-Ganz catheter in the same heart case for dissimilar reasons.

Example: Your anesthesiologist places a Swan-Ganz line in order to monitor cardiac output, and place a CVP line distinctly due to the need for multiple central vein IV access.

In case two separate lines for the procedure are documented on the medical record, you can go ahead and code both and expect separate reimbursement. Report CPT codes 93503 and 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older). Since you need to show that the CVP line is distinct, append modifier 59 (Distinct procedural service) to 36556. In case the insertion sites are different, this is a clear indication that the CVP was separate from the SGC.

Roadblock: You can’t assume that simply because two lines were placed that you are reporting and billing for two CPT codes. You must find clear documentation presenting that your anesthesiologist placed a CVP line, followed by the Swan-Ganz, and mention that the CVP was placed as part of the SGC insertion.

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