We are confused on what CPT and ICD-9 codes should be used for placement of a midline catheter. We were using code 36000, but our auditor recommends code 36569-74 (local anesthesia is used) based on CPT Assistant September 2014. The intent is to place a midline, not a PICC, so there is some confusion as to why code 36000 isn't appropriate.
Full Answer
ICD-9-CM V58.81 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V58.81 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes).
Presence of midline shift is an indication for neurosurgeons to take measures to monitor and control ICP. Immediate surgery may be indicated when there is a midline shift of over 5 mm. The sign can be caused by conditions including traumatic brain injury, stroke, hematoma, or birth deformity that leads to a raised intracranial pressure.
Midline shift. The sign is considered ominous because it is commonly associated with a distortion of the brain stem that can cause serious dysfunction evidenced by abnormal posturing and failure of the pupils to constrict in response to light. Midline shift is often associated with high intracranial pressure (ICP), which can be deadly.
Immediate surgery may be indicated when there is a midline shift of over 5 mm. The sign can be caused by conditions including traumatic brain injury, stroke, hematoma, or birth deformity that leads to a raised intracranial pressure. Doctors detect midline shift using a variety of methods.
“Midline shift” has no ICD-10 code to support severity metrics. Consider Brain Compression and/or Cerebral Herniation when a midline shift is present. Also, document any Cerebral Edema independently to help support the Severity of Illness (SOI) and Risk of Mortality (ROM) of your patient.
ICD-10 code Z71. 9 for Counseling, unspecified is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Improved quality of data. The granularity of ICD-10-CM and ICD-10-PCS is vastly improved over ICD-9-CM and will enable greater specificity in identifying health conditions. It also provides better data for measuring and tracking health care utilization and the quality of patient care.
ICD-10-CM Code for Encephalopathy, unspecified G93. 40.
Z71. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
09 for Observation of other suspected mental condition is a medical classification as listed by WHO under the range -PERSONS WITHOUT REPORTED DIAGNOSIS ENCOUNTERED DURING EXAMINATION AND INVESTIGATION.
The biggest difference between the two code structures is that ICD-9 had 14,4000 codes, while ICD-10 contains over 69,823. ICD-10 codes consists of three to seven characters, while ICD-9 contained three to five digits.
CMS will continue to maintain the ICD-9 code website with the posted files. These are the codes providers (physicians, hospitals, etc.) and suppliers must use when submitting claims to Medicare for payment.
The U.S. also uses ICD-10-CM (Clinical Modification) for diagnostic coding. The main differences between ICD-10 PCS and ICD-10-CM include the following: ICD-10-PCS is used only for inpatient, hospital settings in the U.S., while ICD-10-CM is used in clinical and outpatient settings in the U.S.
Q: I would like to add encephalopathy due to urinary tract infection (UTI) to our quick coding tips. Coding Clinic instructs coding professionals to code as G93. 49, other encephalopathy, which is now a CC.
When the encephalopathy is a principal diagnosis, auditor denials are not the issue; the real concern is with the documentation not supporting it as a reportable condition. Think of encephalopathy as on a continuum with acute confusion, delirium, and encephalopathy, because everything isn't encephalopathy.
Acute encephalopathy and delirium are clinically similar, but for coding purposes, very different. Delirium is a low-weighted symptom; encephalopathy is a serious, high-weighted medical condition. Delirium is usually due to an underlying encephalopathy, and clinicians should document as such if clinically present.
Doctors detect midline shift using a variety of methods. The most prominent measurement is done by a computed tomography (CT) scan and the CT Gold Standard is the standardized operating procedure for detecting MLS. Since the midline shift is often easily visible with a CT scan, the high precision of Magnetic Resonance Imaging (MRI) is not necessary, but can be used with equally adequate results. Newer methods such as bedside sonography can be used with neurocritical patients who cannot undergo some scans due to their dependence on ventilators or other care apparatuses. Sonography has proven satisfactory in the measurement of MLS, but is not expected to replace CT or MRI. Automated measurement algorithms are used for exact recognition and precision in measurements from an initial CT scan. A major benefit to using the automated recognition tools includes being able to measure even the most deformed brains because the method doesn’t depend on normal brain symmetry. Also, it lessens the chance of human error by detecting MLS from an entire image set compared to selecting the single most important slice, which allows the computer to do the work that was once manually done.
The sign is considered ominous because it is commonly associated with a distortion of the brain stem that can cause serious dysfunction evidenced by abnormal posturing and failure of the pupils to constrict in response to light. Midline shift is often associated with high intracranial pressure (ICP), which can be deadly.
Three main structures are commonly investigated when measuring midline shift. The most important of these is the septum pellucidum, which is a thin and linear layer of tissue located between the right and left ventricles. It is easily found on CT or MRI images due to its unique hypodensity. The other two important structures of the midline include the third ventricle and the pineal gland, which are both centrally located and caudal to the septum pellucidum. Identifying the location of these structures on a damaged brain compared to an unaffected brain is another way of categorizing the severity of the midline shift. The terms mild, moderate, and severe are associated with the extent of increasing damage.
We are confused on what CPT and ICD-9 codes should be used for placement of a midline catheter. We were using code 36000, but our auditor recommends code 36569-74 (local anesthesia is used) based on CPT Assistant September 2014. The intent is to place a midline, not a PICC, so there is some confusion as to why code 36000 isn't appropriate.
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From a CPT coding perspective and based solely upon the information provided in your inquiry, the recommended to report codes 36568, Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under 5 years of age, or 36569, Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older, for PICC insertion for midline placement has not changed . As stated in CPT Changes 2004 when the codes were created, “To qualify as a central venous access catheter or device, the tip of the catheter/device must terminate in the subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena cava, or the right atrium. The venous access device may be either centrally inserted (jugular, subclavian, femoral vein or inferior vena cava catheter entry site) or peripherally inserted (eg, basilic or cephalic vein). The device may be accessed for use either via exposed catheter (external to the skin), via a subcutaneous port or via a subcutaneous pump.” These guidelines and the reporting of PICC insertion codes for midline placement are still in place.
Therefore, the RUC agreed to refer this issue to CPT to create specific codes that are more descriptive of the actual service being performed.
Please note that CPT Information Services is unable to address the coding practices of healthcare facilities. Eligibility for payment, as well as coverage policy, is determined by each individual insurer or third party payer, therefore, you may wish to contact your local third party payer for specific reporting requirements.