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Janine Pritchett
Outpatient PICC's - how do you handle these?

I am looking for algorithym's on how outpatient PICC's are handled.  Specifically:  where are they admitted, is there a bundled charge for the "visit", for pediatrics that need sedation is it different, what if the physician who orders that PICC is from another facility (we are a referral center) - who becomes the physician of record and do you need one, who then writes the orders for the CXR, and so on.......  We are having a lengthy "discussion" with our hospitalists and so am needing to get information.  Thanks in advance for your responses.

Janine Pritchett, RNC, BSN

Clinical Supervisor, IV Therapy

Our outpatient PICCs are
Our outpatient PICCs are done in the Outpatient Infusion Dept.  The charges are not bundled becuase outpatients are charged differently.  Their has to be an order from a MD that does have privileges in our facility. The PICC ordering physician also orders the CXR. We don't do peds, so I can't help  you there.
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Outpatient PICC lines are billed  by a code called APC which pays appox $620.  It is a bundled code for all supplies and labor.  However you should be a able to bill conscious sedation separate as this is not a normal part of PICC coding and is a special patient need

As far as ordering physician on UB-92 form I would assume it would have to be a physician wiith privleges at your institution.  Your best bet is to contact an MD Anderson who do a ton of outpatients and see how they handle referrals from outside the system as they do get them


Kathy Kokotis

Bard Access Systems

Does anyone know what the

Does anyone know what the re-imbursement factor would be for PICC line placement in an out-patient radiology imaging center?  I am very interested in finding out any information anyone may have in regards to placement of PICC lines in an OP imaging center in general.

Thanks in advance 

judy Rivera
I just had a neurosurgeon
I just had a neurosurgeon ask me today how to handle patients that call when they are at home with a picc that has "come out a bit". He wants them to go to the ER and have the picc nurse assess the patients there. What would you suggest? I work for UF & Shand's and we do not have a picc nurse available 24/7. I am a nurse on the picc team.
Some one has got to make an

Some one has got to make an assessment of how much was pulled out, where is the current tip location and what fluids/meds are being infused. A decision must be made about the safety of the current tip location with regard to what is being infused and how long therapy is still required. This may mean that no action is needed up to an including exchange of this catheter or insertion of a new catheter. All patient education must include teaching the patient to never push the catheter back in. I am not sure what would be the best process for your situation but this assessment must be done by someone with the skill and knowledge to make appropriate decisions.  


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

kathy mohn-las vegas In our

kathy mohn-las vegas

In our facility-the physician ordering the PICC must send a recent H&P to the hospital

with a set of orders for the PICC-these can be faxed back and forth-the facility has a

pre-printed order for PICC placement/evaluation by the IV Team.  The patient receives

a patient number. etc and the PICC is usually placed in the Radiology Department by

PICC Nurses and ultrasound.  The thought here is that there is physician back-up

available if needed-and it has been on occasion (for medical problems).  The CXR is on

the pre-printed orders.  Children-especially the little ones are admitted to Peds and

scheduled around the Intensivist's schedule because they usually do receive concious

sedation AND the Child Life Specialist.  They are all  discharged after the procedure.

kathy mohn-las vegas

I was under the impretion
I was under the impretion the reimbursement was more then $600.  W eare talking about our nurses doing OP PICC's I was told reimbursement was approx $800 plus cost of supplies.  Any more info anyone has on nurses doing them not IR would be great.  Thanks Susan
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