Anesthesia Coding Alert

Question: Is there a code we can file for ultrasound guidance with 36620? Some of our providers say they are able to bill 36620 with an ultrasound guidance code, Swan-Ganz catheter placement, and CVP line placement. If so, what should we use?

Connecticut 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 you can use to 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), and/or arterial lines (36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous). Append modifier 26 (Professional component) for proper reimbursement.

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 (MUE’s) 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. You’ll need documentation to support ultrasound guidance, such as a procedure note anatomical notations and an indication that a hard-copy image is saved to the patient’s medical record.