Ask Dr. Z

We are confused on what CPT and ICD-9 codes should be used for placement of a midline catheter. We were using code 36000, but our auditor recommends code 36569-74 (local anesthesia is used) based on CPT Assistant September 2014. The intent is to place a midline, not a PICC, so there is some confusion as to why code 36000 isn't appropriate. Also, wouldn't we change 38.97 to 38.99 as well, since these are not in the central circulation? Here is an example of our dictations: "An appropriate arm vein for line access in the upper arm was widely patent, and a hardcopy ultrasound image was recorded. 1% lidocaine was used for local anesthesia. Using ultrasound guidance, real-time visualization of midline needle entry was used to gain access to the patent right basilic vein above the antecubital fossa. The midline was deployed and was flushed with saline and fixed to the skin. Tip of the midline catheter lies in the peripheral venous circulation distal to the axillary vein. IMPRESSION: Successful right 18-gauge midline placement with use of real-time ultrasound."