2016 HEMODIALYSIS CATHETERS

CODING AND REIMBURSEMENT

GUIDE

Contents

Overview of Central Venous Access Catheters for Hemodialysis 2

Procedures Using Hemodialysis Catheters 2

Physician Reimbursement for Hemodialysis Catheters 3

Hospital Outpatient Reimbursement for Hemodialysis Catheters Under

Ambulatory Payment Classification (APC) 8

Ambulatory Surgery Center Payment for Hemodialysis Catheters 10

Hospital Inpatient DRGs for Hemodialysis Catheters 12

Common Diagnosis (Dx) Codes for Hemodialysis Catheters 13

Overview of Central Venous Access Catheters for Hemodialysis
Since 1983, Medicare has paid dialysis facilities a predetermined, bundled rate intended to cover a specific bundle of services
provided to patients in a given dialysis treatment. However, payment for procedures involving the hemodialysis catheter are
separately payable outside the outpatient dialysis services bundle.

Covidien produces a variety of catheters used to perform hemodialysis in patients with renal failure.1 These catheters are
Central Venous Access Catheters, intended to be inserted via a central vein – typically, the jugular, subclavian, brachiocephalic
or femoral veins.

Once inserted, the internal tip of the catheter is advanced into the superior or inferior vena cava or into the right atrium of the
heart. To be used for hemodialysis, the catheters have two lumens with two caps that hang outside the body.

Procedures Using Hemodialysis Catheters

Current Procedural Technology (CPT)® codes are used by physicians for all sites of service, and by hospitals and Ambulatory
Surgical Centers (ASC) for outpatient procedures.

Summary of Codes:
There are seven different types of procedures that can be performed using central venous access devices:

(1) Insert; (2) Replace; (3) Remove; (4) Repair; (5) Remove Obstruction; (6) Reposition; or (7) Evaluate Catheter

Each procedure has a specific set of CPT® codes as shown in the table below. Different CPT® codes are used depending on
several factors:2

ƒƒ Non-Tunneled (acute, short term use) or Tunneled (chronic, long-term use)

ƒƒ Use of Single Catheter vs. Two-Catheter System
ƒƒ Patient’s Age (< 5, age 5 and older)

REPLACE
COVIDIEN REMOVE
CATHETER TYPE INSERT (VIA SAME REMOVE REPAIR REPOSITION EVALUATE
PRODUCT OBSTRUCTION
ACCESS)
36555 Declotting:
(<5 years) 36593
Non-tunneled Acute 36580 E/M code
36556
(>5years) Outside
36575 Catheter:
36557 36597
(<5years) 36595, 75901 &
Tunneled Chronic 36581 36589 &
36558 36010-36012 36598
76000
(>5 years)
Inside
Catheter:
2 Catheter Tandem- 36565 36581 36589 36575 36596, 79502
System, Tunneled Cath™ (any age) (x2) (x2) (x2) & 36010-36012

2
Physician Reimbursement for Hemodialysis Catheters
National Average Medicare reimbursement for physician services related to Covidien hemodialysis catheters is provided in this
section. These amounts will vary based on the physician’s specific Medicare locality.

Reimbursement is subject to the following payment rules:

Global Days
During a global period, services related to the initial dialysis catheter procedure are not separately payable, as follows:

ƒƒ 0 day global: related services same day as the procedure are not separately paid; services on following days are paid
separately
ƒƒ 10 day global: related services on the same day and for 10 days after are not separately paid

Multiple Procedure Discounting

When two or more procedures are performed during the same encounter, the higher-valued codes pay at 100% and other
codes pay at 50% of the rate. Discounting applies to codes marked “Y”. Codes marked “N” always pay at 100%.

Non-Facility and Facility Payment

Codes have different payments depending on the setting in which the procedure was performed.

ƒƒ Non-Facility refers to physician payment when procedures are performed in the office setting
ƒƒ Facility refers to physician payment when procedures are performed in a hospital or an ASC

Generally, Non-Facility payments are higher since the physician incurs all costs in the office whereas the hospital/ASC incurs
costs in the Facility.

Medicare National Average Payments for Physicians3

Insertion of Catheter:
Different CPT® codes are assigned depending on several factors: whether the catheter is non-tunneled (ie. for acute, short-
term use) or tunneled (ie. for chronic, long-term use); whether the catheter is centrally inserted or peripherally inserted (as
noted, Covidien dialysis catheters are centrally-inserted); the patient’s age; and whether the system uses two catheters.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

36555, Insertion of non-tunneled centrally inserted central

0 N $262 $122
venous catheter, younger than 5 years of age
36556, Insertion of non-tunneled centrally inserted central
0 N $238 $124
venous catheter, age 5 years or older
36557, Insertion of tunneled centrally inserted central
10 Y $1,029 $341
Catheter venous catheter, younger than 5 years of age
Insertion
36558, Insertion of tunneled centrally inserted central
10 Y $799 $287
venous catheter, age 5 years or older
36565, Insertion of tunneled centrally inserted central
venous access device, requiring 2 catheters via 2 separate
10 Y $995 $364
access sites, without subcutaneous port or pump (e.g. Tesio
type catheter)

3
Medicare National Average Payments for Physicians3
Replacement of Catheter4
Via Separate Venous Access: If replacement involves removing an existing dialysis catheter and inserting a new dialysis catheter
via separate venous access, two codes may be assigned: (1) insertion of the new catheter (see Insertion Table above), and (2)
removal of the old catheter (see Removal Table below). Both codes can be billed together and no modifier is required.

Via Same Venous Access: Codes below are assigned when replacement involves removing the existing dialysis catheter and
inserting the new dialysis catheter through the same venous access site, eg. over-the-wire. Codes differ depending on whether
the catheter is non-tunneled or tunneled.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

36580, Replacement, complete, of a non-tunneled

Catheter centrally inserted central venous catheter, without 0 N $219 $69
Replacement, subcutaneous port or pump, through same venous access
Same Venous 36581, Replacement, complete, of a tunneled centrally
Access inserted central venous catheter, without subcutaneous 10 Y $785 $204
port or pump, through same venous access

Removal of Catheter
Dialysis catheters are removed both during replacement, and also when a patient receiving acute, short-term therapy no
longer requires dialysis. Non-tunneled catheters are known to have been removed by health care practitioners without surgery
and there is no procedure code for this. An E&M office visit code can be billed as appropriate for the visit during which the
removal took place. Removal of tunneled catheters, however, requires surgical dissection to release the catheter.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

No code for removal of non-tunneled catheter Payable under E/M code for visit, as applicable
Catheter
Removal 36589, Removal of tunneled central venous catheter,
10 Y $169 $142
without subcutaneous port or pump

4
Medicare National Average Payments for Physicians3
Imaging Guidance for Insertion, Replacement and Removal
Two additional codes can be billed for imaging guidance. These codes must be billed with either a catheter insertion,
replacement, or removal code. The code depends on the type of imaging used. If both ultrasound guidance and fluoroscopic
guidance are performed, both 76937 and 77001 can be assigned together with the dialysis catheter code.

NON-
FACILITY
FACILITY

MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION GLOBAL DAYS
DISCOUNTING PAYMENT PAYMENT

+76937, Ultrasound guidance for vascular access

requiring US evaluation of potential access sites,
documentation of selected vessel patency, concurrent NA N $31 -
real-time US visualization of vascular needle entry, with
permanent recording & reporting
+76937-26, US guidance for vascular access, professional
NA N - $14
component
Imaging +77001, Fluoroscopic guidance for central venous access
Guidance device placement, replacement, or removal (includes
fluoroscopic guidance for vascular access & catheter
manipulation, any necessary contrast injections through NA N $70 -
access site or catheter w/related venography, radiologic
S&I and interpretation and radiographic documentation
of final catheter position)
+77001-26, Fluoroscopic guidance, CVAD, professional
NA N - $19
component
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for
both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26
to receive payment for the professional component only.

Repair of Catheter
Some catheters can be repaired, for example by replacing a damaged segment or component. There is just one code for repair.
For repair of a two catheter system, bill the procedure with frequency of “2” if both catheters are repaired.

NON-
FACILITY
FACILITY

MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION GLOBAL DAYS
DISCOUNTING PAYMENT PAYMENT

36575, Repair of tunneled or non-tunneled central venous

Catheter
access catheter, without subcutaneous port or pump, 0 Y $170 $36
Repair
central or peripheral insertion site

5
Medicare National Average Payments for Physicians3
Removal of Obstruction from Catheter
There are three basic ways to remove clots and thrombus, fibrin sheaths and other obstructive material from dialysis catheters:
(1) declotting by injection, (2) removing external obstruction, or (3) removing internal obstruction.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

Declotting catheter by injecting thrombolytic agent (e.g. Urokinase or tPA) into the catheter
36593, Declotting by thrombolytic agent of implanted
NA N $31 -
vascular access device or catheter
Note: Code 36593 is not payable to the physician when performed in a hospital or ambulatory surgery center, because the
service is typically performed by a facility-employed nurse.
Removing obstruction from around the outside of catheter (e.g. stripping a fibrin sheath off a catheter with a snare) Three
codes are needed to describe the procedure: (1) 36595 to remove obstruction; (2) 75901 for associated imaging; and (3)
36010-36012,depending on the vein, for placing the snare.
36595, Mechanical removal of pericatheter obstructive
material (eg. fibrin sheath) from CVAD via separate venous 0 Y $597 $191
access
75901, Mechanical removal of pericatheter obstructive
material (eg. fibrin sheath) from central venous access
NA N $179 -
device via separate venous access, radiological
Removal of supervision and interpretation
Obstruction
from *75901-26, Radiological Supervision and Interpretation
NA N - $24
Catheter (S&I), Professional Component
36010-36012, Introduction of catheter, vein NA Y $512-$878 $127-$181
Removing obstruction from inside of catheter (e.g., using an intraluminal brush):
Three codes are needed to describe the procedure: (1) 36596 to remove obstruction; (2) 75902 for associated imaging;
and (3) 36010-36012,depending on the vein, for placing the brush.
36596, Mechanical removal of intraluminal (intracatheter)
obstructive material from central venous access device 0 Y $136 $46
through device lumen
75902, Mechanical removal of intraluminal (intracatheter)
obstructive material from central venous access device
NA N $72 -
through device lumen. radiological supervision and
interpretation
*75902-26, Radiological S&I, Professional Component NA N - $19
36010-36012, Introduction of catheter, vein NA Y $512-$878 $127-$181
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for
both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26
to receive payment for the professional component only.

6
Medicare National Average Payments for Physicians3
Repositioning Catheter
The catheter can be moved back to its proper location if it has migrated out of position. This is done under fluoroscopic
guidance.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

36597, Repositioning of previously placed central

0 Y $129 $63
venous catheter under fluoroscopic guidance
Repositioning
76000, Fluoroscopy, up to 1 hour physician time NA N $47 -
Catheter
*76000-26, Fluoroscopy, up to 1 hour physician time,
NA N - $8
professional component
* In the office, if the physician owns the equipment, radiology codes are billed without modifiers and the physician receives payment for
both technical & professional components. In the facility, the hospital or ASC owns the equipment and the physician bills with modifier -26
to receive payment for the professional component only.

Catheter Evaluation
When a catheter is not functioning properly, it is injected with contrast & imaged to identify obstruction/malposition.

NON-
FACILITY
FACILITY

GLOBAL MULT PROC CY2016 CY2016

PROCEDURE CODE AND DESCRIPTION
DAYS DISCOUNTING PAYMENT PAYMENT

36598, Contrast injections for radiologic evaluation

of existing central venous access device, including 0 NA $112 $38
Catheter fluoroscopy, image documentation and report
Evaluation Note: Code 36598 is payable when it is the only service the physician performed. However, when any additional service
payable to the physician is performed on the same date, the catheter evaluation is bundled into the other service and code
36598 is not paid separately.5

HCPCS Device Codes

For procedures performed in the office where the physician incurs the cost of the catheter, the physician can bill the HCPCS
code for the catheter in addition to the CPT® code for the procedure of placing it. However, many payers include payment for
the device in the payment for the CPT® procedure code and do not pay separately for the catheter itself.

HCPCS CODE DESCRIPTION COMMENT

Implantable access catheter (e.g., venous, arterial, epidural

A4300 Can be used for all dialysis catheters.
subarachnoid, or peritoneal etc), external access

7
Hospital Outpatient Reimbursement for Hemodialysis Catheters Under
Ambulatory Payment Classification (APC)
Under Medicare’s methodology for hospital outpatient payment, each procedural CPT® code is assigned to a specific
Ambulatory Payment Classification (APC) with a flat payment rate. Depending on the procedures performed, multiple APCs can
be assigned for each case.

Medicare Average Payments for Hospital Outpatient

STATUS MULT PROC CY2016
PROCEDURE CODE AND DESCRIPTION APC
INDICATOR6 DISCOUNTING7 PAYMENT

36555, Insertion of non-tunneled catheter, younger than 5

T Y 5181 $862
years of age
36556, Insertion of non-tunneled catheter, age 5 years or
T Y 5181 $862
older
Catheter
36557, Insertion of tunneled catheter, younger than 5 years
Insertion T Y 5182 $2,247
of age
36558, Insertion of tunneled catheter, age 5 years or older T Y 5182 $2,247
36565, Insertion of tunneled centrally inserted central
T Y 5182 $2,247
venous access device, 2 catheters
36580, Replacement, non-tunneled catheter T Y 5181 $862
Replacement,
36581, Replacement, tunneled catheter T Y 5182 $2,247
Same Venous
Access Note: When replacement is performed via separate venous access, both catheter insertion (see above) and catheter
removal (see below) are coded. However, payment is made for catheter insertion only.

Catheter No code for removal of non-tunneled catheter Payable under E/M code for clinic visit, as applicable
Removal 36589, Removal of tunneled catheter Q2 Y 5391 $482
+76937, Ultrasound guidance for vascular access N - -
Imaging
Guidance +77001, Fluoroscopic guidance for central venous access
N - -
device (CVAD)
Repair 36575, Repair of tunneled or non-tunneled catheter T Y 5391 $482

8
Medicare Average Payments for Hospital Outpatient
STATUS MULT PROC CY2016
PROCEDURE CODE AND DESCRIPTION APC
INDICATOR6 DISCOUNTING7 PAYMENT
Declotting catheter by injection
36593, Declotting by thrombolytic agent of catheter T Y 5291 $199
Removing obstruction from around outside of catheter
36595, Mech. removal, pericatheter obstructive material
T Y 5182 $2,247
(eg. fibrin sheath)
Removal of 75901, Radiological S&I N - -
Obstruction
from Catheter 36010-36012, Introduction of catheter, vein N - -
Removing obstruction from inside of catheter
36596, Mech. removal of intraluminal (intracatheter)
T Y 5181 $862
obstructive material
75902, Radiological S&I N - -
36010-36012, Introduction of catheter, vein N - -
Repositioning 36597, Repositioning of previously placed catheter T Y 5181 $862
Catheter 76000, Fluoroscopy S N 5523 $191
36598, Contrast injections for radiologic evaluation of
Evaluation T Y 5291 $199
existing (CVAD)

HCPCS Device Codes

In addition to the CPT® code for the procedure, hospitals bill the HCPCS code for the catheter itself, as well as guidewires and
introducer sheaths. However, payment for the catheter and the other items is included in the payment for the CPT® procedure
code and the HCPCS codes are not separately paid.

HCPCS CODE DESCRIPTION COVIDIEN PRODUCT

C1750 Catheter, hemodialysis/peritoneal, long-term Chronic
C1752 Catheter, hemodialysis/peritoneal, short-term Acute
C1769 Guidewire
NA
C1892 Introducer Sheath

Medicare Billing
For Medicare, C-codes are typically used.

HCPCS CODE DESCRIPTION COMMENT

Implantable access catheter (e.g., venous, arterial, epidural subarachnoid,
A4300 Code can be used for all dialysis catheters.
or peritoneal etc), external access

Non-Medicare Billing
Some non-Medicare payers accept C-codes but more commonly, hospitals submit the regular HCPCS code. Many payers
include payment for the device in the payment for the CPT® procedure code and do not pay separately for the catheter itself.

9
Ambulatory Surgery Center Payment for Hemodialysis Catheters
Medicare payment for procedures performed in an ambulatory surgery center is adapted from hospital outpatient APCs and
physician office payments. Medicare only pays for surgical procedures performed in the ASC. Imaging services are usually not
separately paid. Generally, there is no separate payment for devices because their payment is included in the payment for the
procedure.

Medicare Average Payments for ASC

PAYMENT MULT PROC CY2016
PROCEDURE CODE AND DESCRIPTION
INDICATOR8 DISCOUNTING7 PAYMENT

36555, Insertion of non-tunneled catheter, younger than 5 years of

A2 Y $482
age
36556, Insertion of non-tunneled catheter, age 5 years or older A2 Y $482
Catheter
36557, Insertion of tunneled catheter, younger than 5 years of age A2 Y $1,256
Insertion
36558, Insertion of tunneled catheter, age 5 years or older A2 Y $1,256
36565, Insertion of tunneled centrally inserted central venous access
A2 Y $1,256
device, 2 catheters
36580, Replacement, non-tunneled catheter A2 Y $482
Catheter
Replacement, 36581, Replacement, tunneled catheter A2 Y $1,256
Same Venous
Access Note: When performed via separate venous access, payment is made for catheter insertion plus, as appropriate,
catheter removal.
No code for removal of non-tunneled catheter Not payable in an ASC
Catheter 36589, Removal of tunneled catheter A2 N $269
Removal
Note: Because ASCs do not have clinics for non-surgical services, removal of non-tunneled catheters is not recognized
in ASC.
+76937, Ultrasound guidance for vascular access N1 - -
Imaging
Guidance +77001, Fluoroscopic guidance for central venous access device
N1 - -
(CVAD)

10
Medicare Average Payments for ASC
PAYMENT MULT PROC CY2016
PROCEDURE CODE AND DESCRIPTION
INDICATOR8 DISCOUNTING7 PAYMENT

Catheter Repair 36575, Repair of tunneled or non-tunneled catheter A2 Y $269

Declotting catheter by injection
36593, Declotting by thrombolytic agent of catheter P3 Y $30
Removing obstruction from around outside of catheter
36595, Mechanical removal of pericatheter obstructive material
P3 Y $453
(eg. fibrin sheath)
Removal of 75901, Radiological S&I N1 - -
Obstruction from
Catheter 36010-36012, Introduction of catheter, vein N1 - -
Removing obstruction from inside of catheter
36596, Mechanical removal of intraluminal (intracatheter) obstructive
G2 Y $482
material
75902, Radiological S&I N1 - -
36010-36012, Introduction of catheter, vein N1 - -

Repositioning 36597, Repositioning of previously placed catheter G2 Y $482

Catheter 76000, Fluoroscopy Z3 N $38
Catheter Evaluation 36598, Contrast injections for radiologic evaluation of existing CVAD P3 Y $83

HCPCS Codes
As instructed by Centers for Medicare and Medicaid Services (CMS), ASCs generally do not use Healthcare Common Procedure
Coding System (HCPCS) device code when billing Medicare.

11
Hospital Inpatient DRGs for Hemodialysis Catheters
Under Medicare’s Diagnosis-Related Groups (DRG) system for hospital inpatient payment, each inpatient stay is assigned to
one of about 750 surgical or medical DRGs based on diagnoses and procedures. Each DRG has a flat payment rate.

ICD-10-PCS Procedure Codes

Procedures with dialysis catheters are typically performed in the outpatient setting. However, some patients who are already
hospitalized may need a dialysis catheter. When insertion is performed as inpatient, the ICD-10-PCS procedure code depends
on the anatomic site where the internal tip of the dialysis catheter rests.10

ICD-10-PCS PROCEDURE CODE CODE DESCRIPTION COMMENT

02HV33Z Insertion of infusion device into superior vena This code is used for centrally and peripherally inserted
cava, percutaneous approach catheters, both non-tunneled and tunneled, when the tip
rests in the superior vena cava or the cavoatrial junction.
02H633Z Insertion of infusion device into right atrium, This code is used for centrally and peripherally inserted
percutaneous approach catheters, both tunneled and non-tunneled, when the
tip rests in the right atrium.

Medicare Average Payments for Hospital Inpatient

Because 02HV33Z and 02H633Z are not considered significant procedures for DRG assignment, non-surgical DRGs are
assigned according to the principal diagnosis. Common ICD-10-CM diagnosis codes are listed at the end of this Guide.
DRG DRG TITLE8 FY 2016 PAYMENT
PRINCIPAL DIAGNOSIS: N18.6, I12.0, I13.11, N17.0-N17.9
682 Renal Failure W MCC $8,909
683 Renal Failure W CC $5,555
684 Renal Failure WO CC/MCC $3,704
PRINCIPAL DIAGNOSIS: I13.2
291 Heart Failure and Shock W MCC $8,746
292 Heart Failure and Shock W CC $5,733
293 Heart Failure and Shock WO CC/MCC $3,979
PRINCIPAL DIAGNOSIS: T80.218A, T80.219A, T82.4-XA, T82.8-8A
314 Other Circulatory System Diagnoses W MCC $11,419
315 Other Circulatory System Diagnoses W CC $5,742
316 Other Circulatory System Diagnoses WO CC/MCC $3,838
PRINCIPAL DIAGNOSIS: E10.22, E11.22
698 Other Kidney and Urinary Tract Diagnoses W MCC $9,169
699 Other Kidney and Urinary Tract Diagnoses W CC $6,051
700 Other Kidney and Urinary Tract Diagnoses WO CC/MCC $4,231

12
Common Diagnosis (Dx) Codes for Hemodialysis Catheters
Hemodialysis catheters are used to treat renal failure. In most patients, the renal failure is chronic and referred to as chronic
kidney disease (CKD) with end stage renal disease (ESRD). ESRD is frequently due to hypertension or diabetes, and the
diagnosis code assignments reflect this.

ICD-10-CM
CODE DESCRIPTION COMMENT
DX CODE
END STAGE RENAL DISEASE
Includes Stage V chronic kidney disease that requires
N18.6 End stage renal disease
dialysis.
NOTE: This diagnosis is designated as an MCC but there are exceptions:
ƒƒ N18.6 does not count as an MCC when sequenced as the principal diagnosis
ƒƒ N18.6 does not count as an MCC when assigned as a secondary diagnosis with the principal diagnosis codes below for diabetes or acute renal failure.
Otherwise, code N18.6 for ESRD does count as an MCC and a DRG W MCC will be assigned when code N18.6 is used as a secondary dx.
END STAGE RENAL DISEASE DUE TO DIABETES
E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease
The diabetes code is sequenced first, followed by N18.6.
E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease
END STAGE RENAL DISEASE DUE TO OR WITH HYPERTENSION
The hypertension code is sequenced first, followed by
I12.0 Hypertensive CKD with stage 5 chronic kidney disease or ESRD
N18.6.
END STAGE RENAL DISEASE DUE TO OR WITH HYPERTENSION WITH HEART DISEASE
Hypertensive heart and CKD without heart failure, with stage 5
I13.11
chronic kidney disease, or ESRD The hypertension code is sequenced first, followed by
Hypertensive heart and CKD with heart failure and with stage 5 N18.6.
I13.2
chronic kidney disease, or ESRD
ACUTE RENAL FAILURE
Although ESRD is a chronic disease, hemodialysis catheters may also be placed to treat acute renal failure.
N17.0 - Codes N17.0-N17.9 may be used together with N18.6 if
Acute kidney failure
N17.9 the patient has both acute renal failure and ESRD.
COMPLICATIONS OF DIALYSIS CATHETERS
When complications arise, hemodialysis catheters may be replaced, removed, or repaired. There are specific codes for catheter
complications. The underlying ESRD is coded as well.
T82.41XA Breakdown (mechanical) of vascular dialysis catheter
T82.42XA Displacement of vascular dialysis catheter
T82.43XA Leakage of vascular dialysis catheter
T82.49XA Other mechanical complication of vascular dialysis catheter
T82.818A Embolism of vascular prosthetic devices, implants and grafts
T82.828A Fibrosis of vascular prosthetic devices, implants and grafts
T82.838A Hemorrhage of vascular prosthetic devices, implants and grafts
T82.848A Pain from vascular prosthetic devices, implants and grafts
T82.858A Stenosis of vascular prosthetic devices, implants and grafts
T82.868A Thrombosis of vascular prosthetic devices, implants and grafts
T82.898A Other specified complication of vascular prosthetic devices, implants and grafts
T80.218A Other infection due to central venous catheter
T80.219A Unspecified infection due to central venous catheter
T80.211A Bloodstream infection due to central venous catheter An additional code can be used with T80.21-A to show the
type of infection. “Local” infection refers to infection at
T80.212A Local infection due to central venous catheter the catheter entrance or exit site, or in the subcutaneous
tunnel.

13
Notes:

1. Renal failure can also be treated with peritoneal dialysis. There are special catheters for peritoneal dialysis but they are not addressed in this Guide.
2. Another factor in CPT® coding is central vs. peripheral insertion (PICC). However, since Covidien’s dialysis catheters are centrally inserted, these are the only
codes provided.
3. All Medicare Physician Fee Schedules calculated using CF $35.8043 effective January 8, 2016 - December 31, 2016. The new CF is reflected in the January
PFS update available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html
4. Partial replacement uses code 36578 but this is only for catheters connected to ports and pumps. Covidien does not manufacture ports or pumps.
5. Medicare National Physician Fee Schedule Relative Value File. Code 36598 is designated as status T: “There are RVUS and payment amounts for these
services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other
services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for
which payment is made.
6. Status Indicators determine payment methodology when multiple APCs are assigned to a case: S- always paid at 100% of the rate; T - paid at 50% of the rate
when submitted with a higher-valued T procedure; N - no separate payment made because procedure is packaged with another primary procedure; Q2 - not
separately payable when submitted with a status T procedure.
7. Multiple Procedure Discounting: When two or more procedures are performed during the same encounter, the higher-valued code pays at 100% of the rate
and the other codes pay at 50% of the rate. This discounting applies to codes marked “Y”. Codes marked “N” always pay at 100%.
8. Payment Indicators determine payment methodology for CPT® codes billed in the ASC: A2 = surgical procedure, payment based on hospital outpatient rate
adjusted for ASC; G2 = non office-based surgical procedure, payment based on hospital outpatient rate adjusted for ASC; N1 = packaged service, no separate
payment ; P3 = office-based procedure, payment based on physician fee schedule; Z3 = radiology service paid separately when provided integral to a procedure,
payment based on physician fee schedule.
9. Most DRGs above are tiered as W MCC, W CC, and WO CC/MCC. MCCs are major complications/ comorbidities. CCs are other complications/comorbidities.
Assignment to a DRG W MCC or W CC occurs if any of the secondary diagnoses assigned to the patient are designated as MCCs or CCs, according to fixed DRG
logic. If none of the secondary diagnosis codes for the case are designated as an MCC or a CC, a DRG WO CC/MCC is assigned.
10. Coding Clinic, 4th Q 2015, p.26-30

The information contained in this guide is for educational purposes only and is not intended to serve as reimbursement advice. The information herein is taken from the
materials published by the Centers for Medicare and Medicaid Services and the American Medical Association and may be helpful to providers in staying up to date on coding
and billing of services. This information is subject to change, and cannot guarantee coverage or reimbursement. Medtronic makes no other representations as to selecting
codes for procedures or compliance with any other billing protocols or prerequisites. As with all claims, providers are responsible for exercising their independent clinical
judgment in selecting the codes that most accurately reflect the patient’s condition and procedures performed for a patient and to consult with each patient’s health plan for
appropriate reporting of each procedure. Providers should refer to current, complete, and authoritative publications such as AMA HCPCS Level II Code publication or insurer
policies for selecting codes based on the care rendered to an individual patient, and may wish to contact individual carriers, fiscal intermediaries, or other third-party payers as
needed
CPT © 2015 American Medical Association. All rights reserved. CPT © is a registered trademark of the American Medical Association.
© 2016 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company.

For more information, contact the Medtronic Reimbursement Hotline: 877-278-7482.

Renal Care Solutions

15 Hampshire Street
Mansfield, MA 02048
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T: (800) 962-9888

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