CPT Port A Cath Procedures Medical Coding

Q: Can you explain the difference between Tunneled versus Non-Tunneled and Centrally inserted vs Peripherally inserted Port-A-Caths?

Handouts, transcripts, enhanced video replay and instructor access are available to CCO Club members. If you are interested in membership visit http://cco.us/club.

A: I went ahead and divide it up into Central Venous Catheters. That’s what we’re really talking about. The question ends up being: What’s the difference between Tunneled and Non-Tunneled? The keywords you’re looking for is how long will the person have the cath. So, a cath is anything that is put into the body to let things in or let things out. It doesn’t have to be in a vessel because we have urinary catheters. But for the most part we’re talking about venous catheters here.
Tunnel catheters are intended to stay for longer periods of time. They go under the skin and they have a separate exit point. That’s how you know it’s tunneled. They can have more than one lumen. Now, when you talk about a lumen, it just means that it’s a tube. So we have lumens in our body. It’s just a tube aspect of the anatomy. But I’ve got some pictures here for you to see. The lumen that they’re talking is going to have probably… If they have two, they have like little two plastic apparatuses that come out and then you can inject things into them separately.

Common names. Some of the top tunneled venous catheters are going to be Hickman. Look for Hickman but it’s called Power Hickman. Then there’s a Multi-Lumen Hickman. Also, you could’ve seen called Broviac Long-Term Dialysis Catheter. Groshong. I used to call it a Grosheng but it’s called a Groshong. I may not even be pronouncing it right then, but to me I call it a Grosheng and everybody just rolled their eyes at me when I was in a hospital. Then there’s another one called Noestar and I don’t know that one as well. But usually it was Hickman or a Groshong that went in.
There are other types of tunneled ports. These are ports that are implanted. For the most part, it’s usually somebody that has more of a chronic or long-term illness that’s going to be treated. Definitely if you’re going to be getting chemotherapy because of cancer or something like that, they’ll put a port in because you know you’re going to be going in frequently to have blood draws done and they need to get medicine in you. This actually makes it more stable for a vein. This is a port that goes under the skin. Again, long-term therapy. It can also have one or more lumens, those little tubes that you would use, but for the most part, you see them with one. The big ones are called PowerPort, Titanium Dome Port, and there’s a SlimPort that is also used.

Let’s look at a picture of those. You know what I don’t think I added the pictures because they were copy written. I don’t think I did. So what you need to do is go out and Google image “central venous catheters”. I was looking at all these and I couldn’t find one that I could get permission to use.
Another type is a dialysis catheter. This is going to be tunneled. It’s going to go usually into the superior vena cava. They can do an arterial venous fistula at a lot of the times that are used and these are called a HemoSplit, and these are long-term dialysis catheters, because people that are doing dialysis or doing at least two times a week.

Now, Non-Tunneled, these are short term. Usually with Non-Tunneled you’re going to see them done a lot of times in the ER. The one that I saw done it was impressive to watch them do was a really difficult job but we have a woman in the ER that had a motor vehicle accident. She rode her car. She didn’t safety belt on and quite honestly broke almost every bone, the doctor said. Her arms which would normally… Look at the length of your arm and her arms was just down to her elbow because she had like shattered both of her arms and so it shortened the arm. They were wanting to put in a cath. They had to do a cut down and get into the subclavian artery and all the time trying to get that done, but it is non-tunneled, short term. They just had to stabilize her enough so they could get her on a helicopter and take her out to the university because of the condition that she was in.

One of this is… There’s all kinds of names formed but the resources I was using this Elite Dialysis Catheter called, and I think this is called… I’m not probably going to say this right – MAHURKAR. That’s a type of temporary dialysis catheter that’s done. They can do the subclavian like I got to see which was a central venous catheter and it had like four or five ports or lumens sticking off of it and they were all color coded, because they were going to have put in multiple IV bags and so on and so forth. These would be central venous catheters. You might see them abbreviated as CVAD.