Anesthesia Coding Alert

Question: Is there a code that can go with 36620 for ultrasound guidance? Some doctors are saying that they are able to bill 36620 along with an ultrasound guidance code, Swan-Ganz catheter placement, and CVP line placement. What is correct?

North Dakota Subscriber

Answer: 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 an add-on code and is correct when you report placement of:

• CVP (36556, Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older)
• Swan-Ganz (93503, Insertion and placement of flow directed catheter [eg, Swan-Ganz] for monitoring purposes
• A-lines (36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous).

You should append modifier 26 (Professional component) to +76937 for proper reimbursement when reporting only the physician’s services.

Also: As a side note, 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) with modifier 26 would be the correct U/S guidance for nerve block placement for postoperative pain management, unless the nerve block states that guidance is included. Keep in mind that payers that follow the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) limit the use of +76937 to two times per day and 76942 to one time per day, regardless of the number of times ultrasound guidance is used. There should also be documentation to support ultrasound guidance, such as a procedure note, anatomical notations, and an indication that a permanently recorded image is saved to the patient’s medical record.