Anesthesia Coding Alert

Question: Some of our physicians say that they are able to bill 36620 with an ultrasound guidance code. Is this correct? If so, what code do we report? Also, can we report ultrasound guidance with CVP or Swan-Ganz line placements?

Utah Subscriber

Answer: Your physicians are correct about being able to code for ultrasound guidance with 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous). As long as the code descriptor does not state that guidance is included and the Correct Coding Initiative does not bundle the services, you can submit 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) with modifier 26 (Professional component) appended.

Ultrasound guidance 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 correct when your provider uses ultrasound guidance while placing a CVP line (36556, Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) or Swan-Ganz catheter (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). Append modifier 26 to the guidance code for proper reimbursement.

Extra tips: Be sure that the documentation supports ultrasound guidance. Also, remember that modifier 26 applies for all situations except when the physician owns the equipment and performs the procedure in his own office. This doesn’t happen much with anesthesia cases that involve line placements, but it’s still an important guideline to remember.