billing for "midline"

[Hamhock]

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I have been working recently as an independent contractor. In addition to the stipend, we bill for our professional services.

I have also recently been placing more and more "midline" catheters. That is, under ultrasound guidance, I have been putting 15-20 cm single, double, and triple lumen catheters into the basilic or brachial veins. This usually leaves the tip of the catheter in the axillary (most often "short" of the confluence created with the internal jugular).

Does anyone else do this and bill for it? How are you coding it? ...like a central line? ...like a PICC?

Thanks,
Hamhock

 

[jdh71]

I have been working recently as an independent contractor. In addition to the stipend, we bill for our professional services.

I have also recently been placing more and more "midline" catheters. That is, under ultrasound guidance, I have been putting 15-20 cm single, double, and triple lumen catheters into the basilic or brachial veins. This usually leaves the tip of the catheter in the axillary (most often "short" of the confluence created with the internal jugular).

Does anyone else do this and bill for it? How are you coding it? ...like a central line? ...like a PICC?

Thanks,
Hamhock

So you are putting central line catheters into a basilic or brachial veins?

 

[Hamhock]

So you are putting central line catheters into a basilic or brachial veins?

Yes.
Sometimes just the smaller and shorter "femoral aline" catheters.
HH

 

[jdh71]

Yes.
Sometimes just the smaller and shorter "femoral aline" catheters.
HH

You have two options in my mind. Bill as a central line until people stop paying for it. Or don't bill for it at all until coding catches up.

The real advantage to "midlines" or long angiocaths with two or three ports is that if they get infected you can't call them a central line infection. But if you're just putting in a central line in the same area I think you'd lose this ability to bypass central line infection. As PICC infections count as central line infections. Maybe all things being equal just put in a traditional central line instead of putting a central line into the upper arm. I'm not convinced the are any advantages and it's a problematic billing issue.

Where I work we are getting set up to do US guided mid line angiocaths. And we're going to have our mid levels put them in since you can't bill for an IV placement.

Maybe this response really didn't help much.

 

[Hernandez]

Ask your coders about the code 36410. I do not know if routine cpt excludes use of this code. If it was an ICU pt, I'd wrap the procedure into CCT