Interventional Radiology

Ultrasound Guidance for Vascular Access: Can I Charge for That?

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

Ultrasound guidance is often used to locate and gain entry into the access vessel for interventional radiology services. One of the most common questions we receive is whether or not ultrasound guidance, when used, can be coded separately. The answer to that question depends on a couple factors:

  • Is ultrasound guidance included in the primary procedure code? With bundled codes there’s a chance it is, so always read the code descriptions carefully.
  • Does the report contain the necessary criteria for coding ultrasound guidance?

Five Things to Look For

+76937 has a five-part list of criteria which are required in order to assign the code:

  1. Ultrasound must be used to evaluate potential access sites, this may involve evaluation of multiple areas to determine which seems most amenable to placement of the catheter.
  2. The report must include documentation of the patency of the vessel selected for the access site.
  3. Ultrasound must be used for real-time visualization of the vascular entry. If the vessel is seen by ultrasound and marked, but ultrasound is not used to guide the needle entry it would NOT be appropriate to code.
  4. There must be documentation of the localization process – this is usually included in the procedure report.
  5. There must be permanent images recorded of the selected vessel.
    It is not required that the interpreting physician actually document permanent images being recorded, but in case of an audit doing so may reduce the need to provide copies of the images.

All five of the above criteria must be performed, but coders should keep an eye out for items 2, 3 and 4 when determining whether or not it is appropriate to code for ultrasound guidance. Documentation such as patent, narrowed or tortuous vessels and visualization of needle entry into the vessel must be in the report.

Good Documentation
These examples would be sufficient to support the assignment of +76937
Lacking Documentation*
These examples would not be sufficient to support the assignment of code +76937
“the right common femoral artery was evaluated with ultrasound, it is normal, images were obtained. The artery was accessed using ultrasound guidance and a micropuncture kit”“percutaneous puncture of the right common femoral artery was performed using single wall puncture technique under real-time ultrasound guidance using a skinny needle”
“a small dermatotomy made, through which the patent left radial artery was punctured percutaneously under direct sonographic guidance with a 21-gauge needle. Permanent sonographic image of arterial puncture achieved.”“the left common femoral vein was accessed with a micropuncture system under ultrasound guidance and a J-wire was advanced and a 5 French sheath was placed”

*Note that in these are examples and it is important to look through the entire report to ensure there was no additional discussion of the access within the report. These examples assume this was the totality of the dictation regarding access under ultrasound guidance.

It’s easy to see the difference between the examples and how, with a few small changes, the question of whether ultrasound guidance for vascular access can be coded (when appropriate) can be easily resolved.