Radiology Coding Alert

You still shouldn't be too hasty in adding the US code to your claim.

A recent Correct Coding Initiative (CCI) edit deletion simplifies reporting ultrasound guidance with arteriovenous (AV) shunt access.

Effective April 1, 2012, for physicians, CCI deleted the edit bundling these two codes, according to Frank Cohen, principal and senior analyst for The Frank Cohen Group, in his NCCI Change Analysis 18.1:

• 36147, Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)
• +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).

The edit had a modifier indicator of 1, meaning that you could override it with a modifier, such as 59 (Distinct procedural service), when appropriate. The edit deletion means you should no longer need to append a modifier for payers to reimburse both codes.

Caution: Before adding +76937 to your 36147 claim, review whether documentation truly supports reporting ultrasound guidance. As CPT® guidelines explain, "Particularly in the case of new or failing AVF [AV fistula], ultrasound may be necessary to safely and effectively puncture the AV access for evaluation, and this may be reported separately with 76937 if all the appropriate elements for reporting 76937 are performed."

In other words, the physician should document the medical necessity for using the ultrasound guidance in the patient's specific case. CPT® guidelines for ultrasound guidance also "require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized."