Anesthesia Coding Alert

Question: We are billing ultrasound guidance as +76937 x 2 when performing two procedures (line placements or pain procedures). I am trying to ascertain if it correct coding to bill this service (76937) twice as we are receiving denials stating we are only allowed to bill once per day.

West Virginia Subscriber

Answer: Start with a clear understanding of what you’re reporting and when it’s appropriate.

Code +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]) is billed when the provider uses ultrasound for vascular needle entry. Take note that it is an add-on code (denoted by the + symbol in the CPT^® book) that cannot be billed alone. If you are submitting +76937 without an associated code, insurers will deny the claim. Insurers will also deny the claim if you report +76937 with certain procedures:

• 37191 – Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed
• 37192 – Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed 
• 37193 – Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed 
• 37760 – Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg 
• 37761 – Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg 
• 76942 – Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation.  

Another option for ultrasound guidance that can sometimes be appropriate is 76942 (as a stand-alone code, not with +76937). You report 76942 when the provider uses ultrasound for needle placement for pain management injections. CPT^® includes a long list of procedures you cannot report with 76942, so be sure to check that before submitting a claim.

Also: If your provider performs two procedures during the encounter, such as two pain management injections, you can only bill the ultrasound once.