General Surgery Coding Alert

Don't miss out on $20 per procedure when your surgeon performs central venous (CV) access device placements. If your physician uses fluoroscopic or ultrasonic guidance during the placement, you should separately report that service. Here's how.

If your surgeon uses ultrasound guidance, report +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]) in addition to the CV access device placement code, says John F.Bishop, PA-C, CPC, MS, CWS, president of Tampa,Fla.-based Bishop and Associates.

Caveat: Don't report +76937 if your physician uses ultrasound only to identify a vein and mark the skin. Code +76937 if he must use ultrasound for actual real-time guidance of needle passage into the venous lumen.

Remember: You can only report this code once per session, even if the surgeon examines multiple sites to select the best site for access.

Alternative: If your surgeon uses fluoroscopic guidance, report +77001 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [List separately in addition to code for primary procedure]), Bishop explains.

This add-on code describes use of fluoroscopic imaging to guide the guidewire and the catheter into the central venous position, according to CPT Changes 2004 -- An Insider's View.

See the dollar signs: If you skip reporting the radiological guidance your surgeon performs, you're forfeiting money. For example, if your surgeon uses ultrasound guidance (+76937), you'll earn $15.87 (the unadjusted professional component fee for +76937, 0.44 RVUs times the 2009 conversion rate of $36.0666) in addition to the procedure code. If your surgeon performs fluoroscopic guidance (+77001), you'll earn $19.12 (the unadjusted professional component fee for +77001, 0.53 RVUs times the 2009 conversion rate of $36.0666) in addition to the procedure code.

Before reporting either +76937 or +77001, keep in mind that if your surgeon provides the interpretation and report for the radiological services in the facility setting,you must append modifier 26 (Professional component) to the ultrasound or fluoroscopy code, cautions Robyn McGinnis, coding specialist for vascular surgery with UPMC in Pittsburgh. The facility will bill separately for use of its equipment, using modifier TC (Technical component).

Plus: You can only code for the ultrasound or fluoroscopic guidance if the same physician reports both the vascular access procedure and the imaging procedure,McGinnis adds.

Make sure that when you append modifier 26 that your surgeon has provided very clear documentation that interpreted the ultrasonic or fluoroscopic guidance,Bishop warns.

Also keep in mind that +76937 and +77001 are addon codes, says Bishop. "This means you can only report these codes in addition to the primary procedure and you do not need (and the codes don't accept) any modifiers other than modifier 26," he adds.