Radiology Coding Alert

Question: If a physician performs an insertion of a tunneled central venous catheter in the patient’s right internal jugular vein, can we report the imaging guidance separately?

Wyoming Subscriber

Answer: Yes, most likely you can report the imaging guidance separately depending on which primary procedure the physician performed.

For example, if the physician performed 36558 (Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older) and used ultrasound guidance for vascular access and fluoroscopic guidance for central venous access device (CVAD) placement, you could assign the following add-on codes:

• +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))
• +77001 (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) (List separately in addition to code for primary procedure))

It should be noted that +76937 and +77001 are add-on codes and must be reported along with a primary procedure code. Plus, these add-on codes are just examples, and other codes may be more appropriate depending on the report you have.

The CPT^® guidelines preceding the central venous access procedures state that imaging guidance codes may be reported separately when the guidance “is used for centrally inserted central venous catheters, for gaining access to the venous entry site, and/ or for manipulating the catheter into final central position.”

At the same time, the guidelines state to not use +76937 and +77001 in conjunction with the following peripherally inserted central venous catheter (PICC) codes:

• 36568-36569 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance …)
• 36572-36573 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion …)
• 36584 (Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the replacement)

Make sure to read the descriptors, as certain codes may not need image guidance reported separately since the guidance is included in the procedure or the procedure is performed without imaging guidance. For example, the 36568-36569 descriptors state “without imaging guidance” while the code descriptors for 36572, 36573, and 36584 indicate the procedures include all imaging guidance.