Coding Q&A By Stephanie L. Dybul, MBA, RT(R)(VI), CIRCC 2019 CPT code changes for IR


This year’s annual CPT changes may seem minor but, depending on your practice’s procedure mix, these changes may have a significant impact. Please consult the CPT® 2019 Professional Edition codebook for introductory language describing the codes and reporting instructions for these changes.


Peripherally inserted central catheter The central venous access family of CPT codes was not affected by bundled coding until this year. Two new codes have been introduced to represent peripherally inserted central venous catheters (PICCs). Two new CPT codes— ”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” and “36573 age 5 years or older”—bundle all associated imaging guidance during PICC insertion.


Existing CPT codes—“36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age” and “36569 age 5 years or older”—were revised to describe PICC insertion performed without imaging guidance. Separate and distinct codes for pediatric patients (younger than 5 years old) continue to be maintained with codes 36572 and 36568. Additionally, a revision has been made to CPT code 36584 for PICC replacement to describe PICC replacement performed with imaging guidance. Do not report 76937 or 77001 in conjunction with 36568, 36569, and do not report 76937 or 77001 with 36572, 36573, 36584.


When ultrasound guidance is performed during PICC insertion, evaluation of the potential puncture sites, patency of the entry vein and real-time ultrasound visualization of needle entry into the vein should be documented in the written and imaging record. Codes 36572, 36573 and 36582 include confirmation of the catheter tip location. If confirmation


imaging is not performed, use modifier -52 (reduced service) in conjunction with the appropriate CPT code.


Reporting the placement of a midline catheter is also addressed in new introductory language. Since midline catheters terminate in the peripheral venous system, they are not considered central venous access devices and may not be reported as a PICC service. Midline catheter placement may be reported with 36400, 36405, 36406 or 36410.


When imaging guidance is performed for all other centrally inserted central venous catheters, for gaining access to the venous entry site and/or for manipulating the catheter into final central position, imaging guidance codes 76937 or 77001 may be reported separately, when documentation of such guidance is supported.


Dilation of urinary tract Two new codes to report dilation of a urinary tract percutaneous access for endourologic procedures were created. CPT codes “50436 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed” and “50437 including new access into the renal collecting system” include dilation urinary tract, all imaging guidance to the dilation procedure and postprocedure tube placement, when performed. These codes are specific for endourologic procedures and exclude the basic dilation of a percutaneous tract during the initial placement of the catheter or device for routine urinary tract drainage or catheter manipulation. When a pre-existing tract is present, use code 50436. When new access into the collecting system is created and subsequently dilated for an endourologic procedure, use code 50437.


Note that CPT code 50395 has been deleted.


Fine needle aspiration A new subsection titled “Fine needle aspiration (FNA) biopsy” has been added to the CPT book with new introductory


guidelines. Several parenthetical notes have been added or revised throughout the CPT code set to accommodate these changes. CPT code 10022 has been deleted and eight new codes have been created. The new FNA codes are structured using a “first lesion” code with a separate add-on code for each additional lesion.


This basic structure is then bundled with an imaging modality for specific and complete reporting. Therefore, imaging guidance codes 76942, 77002, 77012 and 77021 may not be reported separately with FNA codes (10005– 10012). Codes are reported by modality and are reported once per lesion sampled in a single session, regardless of the number of needle passes into a lesion required to obtain an adequate sample. Add-on codes should be used for additional lesions sampled in the same setting. If a more descriptive CPT code exists for the lesion being sampled, use that CPT code (e.g., breast, pleura, disc space).


#•10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion


+#•10006 each additional lesion (List separately in addition to code for primary procedure)


#•10007 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion


+#•10008 each additional lesion (List separately in addition to code for primary procedure)


#•10009 Fine needle aspiration biopsy, including CT guidance; first lesion


+#•10010 each additional lesion (List separately in addition to code for primary procedure)


#•10011 Fine needle aspiration biopsy, including MR guidance; first lesion


+#•10012 each additional lesion (List separately in addition to code for primary procedure)


General fluoroscopy Code 76001 (fluoroscopy greater than one hour) has been deleted to reflect low usage in current clinical practice.


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