Radiology Coding Alert

Question: For PICC line placements, our radiologist's report indicates direct sonographic guidance along with fluoroscopic guidance. This is indicated on all reports. Can we bill both 76937 and 75998?
     
Louisiana Subscriber

Answer: Yes, you can report both codes together. This is an excellent question, because the Medicare rules for add-on codes 75998 and 76937 have been changed more than once in 2004.
 
As of April 1, you no longer have to append modifier -59 (Distinct procedural service) to steer clear of edits bundling CPT codes +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]) and +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). 
 
CMS decided to remove the 75998 and 76937 edits that took effect in January 2004. ACR and others argued that ultrasound guidance is not included in 75998 (Fluoroscopic guidance), because ultrasound guidance requires different skills and equipment, and therefore different qualifications from fluoroscopic guidance. 
 
Being able to code 75998 for Medicare can boost reimbursement by $73.56, and 76937 will yield another $34.35, but remember to make sure the documentation matches the code descriptions. Code 76937, for example, requires "permanent recording and reporting," so be sure your facility's equipment is capable of this permanent image before using this code.
 
Many handheld ultrasound devices can't preserve a permanent image, so you can't bill for the use of ultrasound. And, the fluoroscopic code requires "radiographic documentation of final catheter position," which also requires a permanent film record. The point is that the scope of services required to justify using these guidance codes is extensive, so pay attention when comparing your reports to your CPT codes. 
 
Remember, both 76937 and 75998 are add-on codes, and both are generally used with codes 36555-36585, for central venous access procedures, but only when imaging guidance is used.