Radiology Coding Alert

Question: I understand that there are very strict guidelines for when add-on CPT 76937 and 75998 can be used in placing access devices. Would you provide some clarification?


Arizona Subscriber

Answer: Look for documentation showing the physician checked the site for patency and performed some form of archival of the imaging before using these codes, and specifically before using 76937.

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) requires documentation that the physician checked the access site to make sure it was patent.
 
You also need to verify that he performed actual ultrasound imaging while placing the needle. The code includes checking other sites also, such as when the radiologist starts at the right jugular vein, finds out that it is occluded, and then moves to the left jugular vein. The physician must retain images from the ultrasound (hard copy or by PACS) and document the guidance in the report. You can also use 76937 for vascular access for angiograms and central venous catheters assuming the same rules for inclusive imaging and documentation.

On the other hand, +75998 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position]) is specific to central venous catheters. Report it when the physician uses fluoro for venography in relation to central venous catheter placement. Example: The physician injects contrast for road mapping before placing a CVL. Report 75998.

Helpful: If he uses ultrasound to find an appropriate access site and to guide the needle into the vein, and then uses fluoro to guide the catheter to its final location, code both 75998 and 76937.

An NCCI edit bundled these two codes together beginning April 1, 2004, but SIR, ACR, and other societies convinced CMS that the edit was incorrect based on the actual test contained within CPT, and the next version of NCCI rescinded the edit.