Anesthesia Coding Alert

Know when to report both lines simultaneously

An Anesthesia & Pain Management Coding Alert subscriber asked for advice in coding a case that included CVP and Swan-Ganz (PA catheter) placement. How would you report it?

Question: Our anesthesiologist placed both a CVP line and a Swan-Ganz catheter during the procedure. Can I bill for both line placements? Can I also code 76937 for ultrasound guidance?

Answer: Coding for the CVP and Swan-Ganz placements depends partly on how your physician completed the procedure. 

Scenario 1: "If a physician places a Swan-Ganz catheter, it is done through the CVP," says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. The anesthesiologist places the CVP line and then threads the Swan-Ganz through the CVP for final placement. He uses the CVP placement as an intermediate step in establishing the Swan-Ganz. Therefore, you bill for the Swan-Ganz line but not the CVP line.

Scenario 2: In some situations, the anesthesiologist might place a second CVP line for additional monitoring during the procedure. Many heart cases include two lines that the anesthesiologist inserts through separate incisions. Documenting separate incisions establishes that they are two distinct procedures, and you may bill them separately.

Nothing in CPT prohibits you from reporting +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]) for vein localization for Swan-Ganz placement.

The key: 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.