Emergency Ultrasound Section Forum
Coding and Reimbursement
Question about Vascular Access Billing
We are considering billing using the CPT code 76937 for our central lines and US guided peripheral IVs. Mu understanding of this additional code was that it required a real time image of needle in vessel, which is of course from a practical standpoint difficult to do for the provider in real time during the procedure. On ACEP website I find the following paragraph that seems to suggest there is an allowance in this CPT code for, given patient safety reasons, taking an image of catheter in vessel after it is secured (copied it below here).
What is everyone using for billing for these procedures? Do you add the CPT code 76937, or are you passing on it given capturing real time images is not practical?
Thank you for any insight!
Brianne Steele, MD RDMS
Director of Emergency Ultrasound
Duke Emergency Medicine
"entry, with permanent recording and reporting."
There are several unique aspects of the central venous and peripheral vascular access with ultrasound guidance code of which users must be aware. The first is that the code is intended for use only when the ultrasound is used with the "dynamic" technique, as opposed to the "static" technique which is not considered a reimbursable service.
The static technique utilizes the ultrasound to identify the vessel, but is not used during line placement. In the dynamic technique the physician uses the ultrasound throughout the procedure from initial identification of the vessel through direct visualization of the needle entering the vessel. A permanently recorded image is required for coding.
When coding a central line placement under direct dynamic visualization with ultrasound it is appropriate to code 76937 for vascular ultrasound guidance and 36556 for the adult central venous line placement.
Of note, the CPT description is interpreted as requiring an image of the target vessel, but not necessarily an image of the needle in the vessel as it is entering. It is believed that obtaining an image of the needle as it is entering the vessel poses unacceptable risks to the patient as it would require the solo operator to take his or her attention away from the procedure in order to obtain an image. It is recommended that permanent recording of the selected vessel or of the needle entering the vessel when this is feasible and safe, while using a procedure note to document the procedure was performed with concurrent real-time visualization. A still image of the catheter in the vessel, once the line is more secure, is acceptable. "
You are correct, the CPT code 76937 is the appropriate code for US-guided vascular access (both central and peripheral). Originally, the requirement was for an archived image of the needle in the vessel, however, as you stated, this is technically challenging. Recently, the requirement for archival changed and is more reasonable. There must be an image of the vessel cannulated (either before or after cannulation is acceptable). In short, at a minimum, simply image the vessel which you are about to cannulate, and that would be sufficient for the billing.
--Jennifer Marin, MD, MSc
--Stan Wu, MD, MBA
Co-Chairs, Coding & Reimbursement Subcommittee, ACEP US Section
Please Note: "Reply" goes to the individual who sent the post.
Target vessel is all you need
Jennifer R. Marin
On Jan 28, 2016, at 11:43 AM, Todd Haber <firstname.lastname@example.org> wrote:
so you can take a picture of the target vessel pre-cannulation and that is good enough…???
that seems iffy to me…
Thank you for this discussion. Despite providing the statements below, I recently received this message stating that Noridian (An independent auditor of CMS) still requires needle visualization. What should I do now to help CMS and Noridian understand ACEP's position? Thank you.
Clarification from Noridian came stating that Yes, we need to have a permanently stored image of the needle being inserted into the vessel. The MD also needs to physically watch the real-time guidance as its being used. It cannot be reported when used only to access the vascular vessel and then to proceed vessel access without using the realtime guidance.