Anesthesia Coding Alert

Question: Can we receive separate payment from Medicare or Medicaid when the physician uses ultrasound guidance (+76937) for an arterial or central line placement if we have proper documentation?

Arizona Subscriber

Answer: Yes, you can receive payment for the service. 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)) is not bunded with either central line or arterial catheter placement. Although you may not have seen arterial lines placed using ultrasound guidance in the past, according to the Western Journal of Emergency Medicine, ultrasound guidance allows for more successful placement with fewer attempts when performed with ultrasound guidance.

Keep in mind: Code +76937 should only be reported when the ultrasound is used with the “dynamic” technique, as opposed to the “static” technique that is not considered a reimbursable service.

In the static technique, the physician uses the ultrasound to identify the vessel but not when placing the line. In the dynamic technique, the physician uses the ultrasound throughout the procedure from initial identification of the vessel through direct visualization of the needle entering the vessel.

If you are reporting either an arterial line 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) or a central line placement 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) for the central venous line placement (assuming the patient is not younger than 5 years of age) under direct dynamic visualization with ultrasound, you can submit +76937 for the ultrasound guidance. You must have a recorded image of the procedure before submitting +76937.