I would like to know what other hospitals are doing with regard to charging for the PowerGlide MIDLINE. Right now we charge for the catheter and supplies, and then we have been placing it under a PICC line procedure charge. This just seems like it's too much of a charge for a more simple procedure. Has anyone built a new procedure charge for placing these? I agree that it is more than placing just a peripheral IV because it's sterile and ultrasound is used. Apparently a Midline charge is billed the same as a PICC according to the AMA CPT? I asked our Bard Rep for some insight and he sent me the following:
Billing and Reimbursement
We cannot instruct a provider how to bill. We can only provide possible codes that may be
appropriate for the activities performed on a particular patient on a particular date of service
which are fully supported by detailed notes in the patient's medical record. The provider of
service must ascertain which codes are appropriate for the activities actually performed.
According to the American Medical Association CPT® Knowledge Base, “A midline catheter is
merely a shorter length peripherally inserted, central venous catheter. Code 36568, Insertion of
peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; under
5 years of age, and 36569, Insertion of peripherally inserted central venous catheter (PICC),
without subcutaneous port or pump; age 5 years or older, for insertion of a peripherally inserted
central venous catheter (PICC) are reported for a midline PICC line. The specific code is selected
based on the specific age given in the code descriptor.”
Code Description
36568
Insertion of peripherally inserted central venous catheter (PICC) without subcutaneous port or
pump; under 5 years of age
36569
Insertion of peripherally inserted central venous catheter (PICC) without subcutaneous port or
pump; age 5 years or older.
I went though this with our experts in coding and billing when the power glide first came to us. It was decided that we can not bill them as PICCs. They are not PICCs as they do not fit the description of a central catheter. As Bard noted, they can not tell you what to do. Our hospital experts decided to not risk the charge of fraud. We bill only for the supplies (I think). At any rate in time and money with a majority of our patients getting stuck more than 3 times during a hospitalization it is still a cost saver. And an incredible patient satisfaction.
Mary Penn RN VA-BC
Saint Charles MO
Mary, are you able to just charge for the use of the ultrasound for the procedure? Thank you so much for your reply. I appreciate the information!
Ann
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
I do not have an entry for charging for the use of an ultrasound. It is capitatated into the PICC insertion charge. I wish there was because I use ultrasound for starting a lot of IVs, especially in obese pts.
Mary Penn RN VA-BC
We are using the following codes
Midlines C1751
Ultrasound 1st vessel 37250
Ultrasound 2nd vessel 37251
Hope this helps
Linda C. Smith, RN
Here are some possible, Reimbursement Codes for Power Midlines, depending on how you are unserting these;
Power Wand® and PowerStick® I
1. CPT or Q-Codes
36568: Placement of a catheter in subclavian or other vein, percutaneous, age 5 or under. (MST)
36569: Placement of a catheter in subclavian or other vein, percutaneous, over age 5. (MST)
Power Wand®, PowerStick® I, and PowerGlide™
76937: Ultrasound insertion of a vascular access device with the aid of ultrasound (CPT/HCPCS) Note: requires “dynamic” technique: “...uses ultrasound during line placement. A recorded image of the procedure is required for coding.”
Power Wand®, PowerStick® I, and PowerGlide™
2. HCPCS Code:
C1751 - Catheter, Infusion, Inserted Peripherally, Centrally or Midline (other than hemodialysis)
“Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services no
t included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting.
Hope this helps.
We use an E&M (evaluation & management- visit code)- per our chargemaster people.
Code is a level 3. 111076
We also charge supplies.
The only way you can charge for US guidance is if you "keep" photo record of it. We don't keep it for Midlines- but do for PICCs. So we are able to charge 707693704 with PICC starts as we print a vessel picture.
Heather Berndt RN, BSN, CEN, CRNI