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Solid documentation a must for successful US claims.

There are several documentation requirements that coders who report procedures involving vascular access with ultrasound (US) guidance need to know.

Read further to find out what you need to know about reporting this procedure.

Get the Basic Details of the Procedure Code

When coding US guidance for vascular access, you may look to code CPT^庐 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 (List separately in addition to code for primary procedure)).

US guidance is used with a multitude of procedures, including nerve blocks, arterial lines, biopsies, joint injections, muscle injections, and more. Some procedures can be performed with or without US guidance with separate CPT^庐 codes 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance) or 20604 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting).

Knowing the appropriate documentation requirements are key to correct reimbursement. This procedure code represents a dynamic visualization of vessel patency and visualized needle entry into that vessel. Simply documenting that a static image for marking was obtained is not sufficient to support billing this code.

Instead, coders need to prioritize capturing and reporting the following information:

1. Documentation of the patency of the selected vessel
2. Concurrent real-time US visualization of vascular needle entry into the vessel; simply documenting a pre/post image for placement is not sufficient to meet the criteria
3. Permanent recording and storage of the images is required to be included in the patient record (The images must be accessible for retrieval upon request from a payor or audit scenario.)

Navigate These Details to Code Correctly

CPT^庐 code +76937 bundles into all cardiac-related procedures but remains separately allowed as an add-on to vascular-related procedures.

CPT^庐 Assistant, December 2004, Issue 12, says: 鈥淲hen ultrasound is used only to identify a vein or skin entry point then the provider proceeds with a nonguided puncture, it is not appropriate to report CPT code 76937.鈥� Also, keep in mind that the codes +76937 and 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) should not be reported together.

Some reimbursement tips to keep in mind are that CPT^庐 code 76937 has both a technical and professional component. To report only the professional component, append the modifier 26 (Professional component). To report only the technical component, append modifier TC (Technical component). To report the complete procedure (i.e., both the professional and technical components), submit the code without a modifier.

If a procedure instructs the coder the report US guidance separately, you can use your CPT^庐 code book to crosswalk to the appropriate US guidance code.

Guidance on whether to report US guidance and the documentation required to support US guidance can be found in multiple chapters of the National Correct Coding Initiative鈥檚 Medicare NCCI Policy Manual, as well as CPT^庐 code descriptions and CPT^庐 section guidelines.

Note: Effective February 14, 2024, the Medicare NCCI Policy Manual was revised, removing code +76937 from the following section NCCI Chapter 9, Section H.12. Code +76937 may be assigned when the documentation requirements are met. This revision will be published in the 2025 Medicare NCCI Policy Manual and has not been released at this time. However, the NCCI Procedure-to-Procedure (PTP) edits were posted December 2, 2024; effective January 1, 2025; and there are 19 CPT^庐 codes that have a PTP edit with CPT^庐 code 76937.

Test Your Knowledge

Below are procedure notes for +76937. See if you can decide whether each of the following scenarios has acceptable or unacceptable documentation, then check your answers at the bottom of the paragraph:

1. Patient presents for a lower extremity diagnostic angiography for bilateral claudication. US is used to determine the suitability of the left femoral artery. US is used as guidance for needle placement, the left femoral artery is deemed patent and suitable for use. Hard copy images and reporting are documented.
2. US documented patency of the access vessel as well as the exact location of the puncture. Images were stored in PACS for documentation purposes. US guided access of the right common femoral artery for sheath placement was performed.
3. A US probe with a left upper extremity visualized the fistula was patent. Local anesthetic was injected and a micro puncture needle was used to gain entry to the AV fistula.
4. Right CFA imaged and vessel found to be patent. Access obtained with US guidance. Images were stored in the record for reporting.
5. The radial pulse was identified. Anesthesia was achieved using 1% lidocaine, to anesthetize the area. The artery was visualized and accessed, using sterile US guidance. Ulnar artery flow was confirmed with US. Images were stored in the patient record.
6. Under real-time US guidance, the needle was advanced with negative pressure into the vein. The needle was seen entering the vessel lumen with a good return of dark red flow, the syringe was removed, non-pulsatile, dark red blood low was noted and the wire was passed without difficulty, then the needle was removed. US confirmed the wire was in the vein, not going into an artery, with no ability to save or print the image.
7. Under US guidance the left common femoral artery was accessed using a micro puncture needle. This was done using the modified Seldinger technique. A 4 French sheath was inserted in the left common femoral artery and over a Bentson wire upsized to an 8 French sheath.

Answers:1. Acceptable 2. Acceptable 3. Unacceptable 4. Acceptable 5. Acceptable 6. Unacceptable 7. Unacceptable

Cristin Robinson, CPC, CPMA, CCC, CRC, Contributing Writer