Anesthesia Coding Alert

Hint:You can sometimes bill both

An Anesthesia & Pain Management Coding Alert subscriber recently sent this question to us about coding for a case that includes CVP and Swan-Ganz (PA catheter) placement. How would you report it?

Scenario: The anesthesiologist places both a CVP line and a Swan-Ganz catheter during the procedure. There is no CCI Edits against this, yet one of my primary coding resources implies that you only bill the Swan-Ganz. Also, would the new ultrasound 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]) be appropriate to report with line placement?

Solution: You can bill both lines, but Debbie Gulledge, CPC, of Anesthesia Associates of Rock Hill in Charlotte, N.C., warns that some carriers will not pay for them both when the anesthesiologist uses as CVP port to thread the Swan-Ganz.

"Your documentation must specify that two separate lines were used," adds Barbara Johnson, CPC, MPC, of Real Code, Inc., in Moreno Valley, Calif.

Also verify that the physician used the lines for separate purposes. If he or she uses the CVP as an intermediate step in establishing the Swan-Ganz, you only bill for the Swan-Ganz. Many heart cases include both lines that are inserted through separate incisions. This establishes that they are two distinct procedures and are separately billable.

As for reporting the ultrasound code, nothing in CPT prohibits you from reporting 76937 for vein localization for Swan-Ganz placement. However, you must be able to provide sufficient documentation of permanent recording and reporting before using 76937. If the equipment cannot generate an ultrasound record, do not report 76937.