# Central Venous Catheter (perma cath insertion) question



## Chlrtrep (Dec 18, 2014)

I am new to a facility and noticed that they do not charge/code  for Fluorscopic guidance (77001) when implanting a tunneled permacath(36558). And it seems to be hit and miss with US guidance (76937).  

I reviewed 15 charts and none for (77001) allthough the physicians dictation clearly static the use of Fluorscopic guidiance.

Of those charts 8 had documented in physician"s dication  the use of Ultrasound for guidance for vasculalr access. Of those, 3 had (76937) coded/charged.

_I asked the department why they are not coding/charging consistently and one staff member said they are medicare patietns so it does not matter we are not getting money for it anyway._So...

If I am reading a report that states permacath(36558) implanted and physicians clearly has documented in his report the us of "fluoroscopic guidance" and the use of "Ultrasound guidance"

I would code 36558,76937,77001   correct.... What are your thoughts


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## Jim Pawloski (Dec 22, 2014)

Chlrtrep said:


> I am new to a facility and noticed that they do not charge/code  for Fluorscopic guidance (77001) when implanting a tunneled permacath(36558). And it seems to be hit and miss with US guidance (76937).
> 
> I reviewed 15 charts and none for (77001) allthough the physicians dictation clearly static the use of Fluorscopic guidiance.
> 
> ...



For u/s guidance, make sure they say that an u/s image was taken.  I would code it all.  It doesn't make a difference who the insurance is, the only way payment is different is if the patient is an in-patient (DRG's).  Out-patient pays by the procedure.
Thanks,
Jim Pawloski, CIRCC


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