Radiology Coding Alert

When your radiologist performs central venous access (CVA) catheter and device insertion, don't get sidetracked and forget to report the imaging guidance, too. CPT guidelines state that you may report +76937 or +77001, as appropriate, and that could add $15 to $100 to your reimbursement.

If your radiologist uses ultrasound guidance, report +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]) in addition to the CV access device placement code, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop and Associates.

Warning: Don't report +76937 if your physician uses ultrasound only to identify a vein and mark the skin.

Report +76937 if he uses ultrasound for actual real-time guidance of needle passage into the venous lumen. You should report this code only once per session, even if the radiologist examines multiple sites to select the best access site.

The Medicare Physician Fee Schedule lists a national rate of $15.87 for +76937's professional component, and $36.79 for the global fee.

If your physician uses fluoroscopic guidance, apply +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]), Bishop says.

This code describes use of fluoroscopic imaging to guide the guidewire and the catheter into the central venous position, according to AMA's CPT Changes 2004:

An Insider's View.

Medicare's national rate for +77001's professional component is $19.12, while the global rate is closer to $104.

Keep in mind that +76937 and +77001 are add-on codes, says Bishop. "This means you can only report these codes in addition to the primary procedure," he adds. In other words, for these services you can code for the ultrasound or fluoroscopic guidance only if the same physician reports both the vascular access procedure and the imaging procedure, says Robyn McGinnis, coding specialist with UPMC in Pittsburgh.