Wiki Ultrasound Guided Access for Catheter Placement Inpatient and Outpatient Scenarios

[WilliamScott]

Hello,
I am trying to get to the bottom of when and how to use CPT 76937 for ultrasound guided placement of a catheter. Most of these occur in the ED (outpatient), my thought was to use 36010 + 76937, but when I look at the Medicare outpatient 2020 Hospital Outpatient Prospective Payment System (0PPS) it states for example, in the ED that 76937, a APC states packaged service and No Separate Payment.

The Medicare Fee Screen average for the professional fee pay scale (average) is $14.80? My wires are crossed that if it occurs in ED how to appropriately code.

Context: I'm part of a work group to determine if we are appropriately coding for US placement of catheters. Many thanks!

 

[thomas7331]

CPT 36010 is for a vena cava catheterization - I think this would very rarely, if ever, be done in the ED. I think you mean 36410?

As an add-on code, CMS has designated 76937 to be contractor-defined as to what base procedures it is allowed to be used with - you'd need to check with your local MAC to know whether or not it could be used for the situation you're seeing, but I don't believe it's not normally allowed with 36410. 76937 is intended for use with more complex venous catheterization procedures and not for the basic guidance needed to perform a common simple venous access for the purpose of administering medications and fluids as is frequently done in the ED.

Regarding the OPPS designation as a 'packaged' procedure, I'd just point out that this is a reimbursement designation which tells you that the payment is included in the APC case rate paid to the facility for the full encounter - it is not a guideline that would tell you whether or not a procedure can or should be coded. Your facility still needs to report all of the services performed, per correct coding guidelines, and you should not omit packaged services just because they don't get their own separate line-item payment.

 

[WilliamScott]

Thanks Thomas!

As a follow up, and maybe you answered this….if so, thanks for your patience, I’m very here.

If I have a patient in the ED, and use ultrasound guided placement of a peripheral IV catheter (in the arm).

Would it be an add on to 36400-36410 depending on location and age of patient?

Or is this covered under APC and would need to solicit feedback with our local MAC.

Thank you again