Ask Dr. Z

"Patient with malpositioned port cath here for repositioning. Access via right common femoral vein, pigtail cath advanced over Bentson wire into right internal jugular vein and manipulated around misdirected port cath. Common femoral vein accessed a second time with endovascular snare cath and advanced over a wire into right atrium. Bentson wire directed through pigtail and ensnared. Both snare and pigtail cath were withdrawn as a unit, successfully repositioning port cath into right atrium." We assigned code 36597 (repositioning of previously placed CVC under fluoroscopy guidance). Your book advised to also use code 76000 — why, when fluoroscopy is stated as part of code 36597? IR advised that code 36010 is specifically for this type of catheter placement. Dr Z’s coding book gives this example on page 178. "4) The port is checked (36598) showing fibrin sheath. Via separate femoral access, a snare is used to perform fibrin sheath stripping of the catheter tip in the superior vena cava (add 36010, 36595, 75901)."  No fibrin sheath is documented. Please explain what codes are correct on this case.