In percutaneous surgery procedures, imaging guidance plays a very important role. For example, the use of ultrasound, fluoroscopy, MRI, CT guidance in biopsy, injection procedures. Also, the imaging guidance CPT code varies from vascular to non-vascular procedures. For non-vascular procedures like biopsy, joint injection, Fine needle aspiration etc. use of ultrasound guidance CPT code 76942 is used. While for coding vascular procedures like central venous catheter placement, CPT code 76937 is report for ultrasound guidance of vascular access.
Similarly, CPT code 77002 is used for coding fluoroscopic guidance for non-vascular procedure and CPT 77001 is used for coding fluoroscopic guidance for vascular procedures. Other the other hand, spinal injection has a separate fluoroscopic guidance CPT code 77003. Let us learn about 76937 cpt code description.
CPT 76937: Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting
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Documentation required for 76937 CPT code
For coding ultrasound guidance 76937, the medical report should completely or clearly document the use of ultrasound imaging guidance. Before assigning 76937 CPT code, we have to check the below specific information in the medical report.
- Evaluation of potential access sites
- Patency of selected vessel
- Concurrent real-time ultrasound visualization of vascular needle entry,
- Permanent recording of images and reporting.
If the medical report documents all the above information clearly, then the report qualifies for assigning ultrasound guidance CPT code 76937. You can check the above information in the below sample coded report.
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Point to remember with Procedure code 76937
Do not report 76937 in conjunction with 37191, 37192, 37193, 37760, 37761, 76942
Also. CPT codes 37760 and 37761 should not be reported in conjunction with CPT codes 76937, 76942, 76998 or 93971.
NCCI Edit Results:
Edit exists with 37760. 76937 is a Column 2 code. If both 37760 and 76937 are submitted, only 37760 will be paid.
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Sample Coded report for CPT code 76937
EXAM: IR PICC LINE PLACEMENT
REASON FOR STUDY: Diffuse non-Hodgkin’s lymphoma, large cell (clinical), :
DIAGNOSIS: Non-Hodgkin’s lymphoma
CONSENT:
The procedure and possible complications were explained to the patient and written informed consent obtained. Complications include, but are not limited to, bleeding, allergic reactions to injected medications, and infection. While these complications are unusual, they are possible.
MEDICATIONS: Local medication only
PROCEDURE/FINDINGS:
The study was performed in an ACR accredited facility. Medication reconciliation form reviewed and any changes related to this procedure resolved. The PICC line site was sterilely prepped and draped. After giving local anesthesia, a 21 gauge needle was used to &puncture the left basilic vein
several cm above the antecubital fossa under ultrasound guidance with a recorded ultrasound image of the patent vessel obtained. Maximal Sterile Barrier Technique was utilized. A 0.018 inch wire was advanced through this into the central veins, as confirmed fluoroscopically. The needle was then exchanged for a peel-away sheath. A 5 French lumen PICC was cut to an appropriate length and advanced through the peel-away sheath. The sheath was removed. The tip of the PICC was located in appropriate position on final recorded fluoroscopic imaging. The line was &aspirated and flushed with saline. The catheter was secured to the skin at the exit site. A sterile dressing was
applied. The patient appeared to tolerate the procedure well.
Ultrasound guidance utilized with an image stored in PACS.
PERFORMED PROCEDURES: Fluoroscopic and ultrasound guided PICC placement.
FLUOROSCOPY TIME: 0.1 min.
IMPRESSION/PLAN:
1. Successful placement of left 41 cm upper extremity double lumen
peripherally inserted central venous catheter.
2. The tip of the catheter is at the caval atrial junction.
3. Line is ready to use.
CPT code: 36569
Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older (code changed or revised in 2019)
In 2019, the CPT code 36569 is revised and will be coded for PICC line placement procedures without imaging guidance. Two new CPT codes have been added, 36572 & 36573 for coding PICC line placement procedures performed with imaging guidance.
36572 – 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; younger than 5 years of age
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; age 5 years or older
Hence, the above sample report will be reported with the CPT code 36572 or 36573 depending on the age of the patient. All the imaging guidance, Fluoroscopy (CPT code 77001) & ultrasound guidance (CPT code 76937) will be included in these procedures codes.
76937
77001
Fluoroscopic guidance for central venous access device placement, replacement, or removal
HCPCS code: C1751
Infusion catheter, inserted peripherally, centrally or midline (other than hemodialysis)
ICD 10: C8330 Diffuse large B-cell lymphoma, unspecified site