General Surgery Coding Alert

Apply modifier -26 for services in a facility setting

You can report imaging services using fluoroscopic or ultrasonic guidance separately under some circumstances, but your documentation must meet CPT and facility criteria.

Call on 76937 for Ultrasound

If the physician uses ultrasound guidance, your code of choice should be +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]).

You may report this procedure along with the appropriate CVA placement code. You can only report this code once per session, even if the surgeon examines multiple sites to select the best site for access, says Deepa Malhotra, CPC, president of Healthcare Educational Resource Services (HERS Inc.) in Chicago.

You shouldn't report 76937 if the physician uses ultrasound only to identify a vein and mark the skin. Rather, the surgeon must use ultrasound for actual real-time guidance of needle passage into the venous lumen, Malhotra says.

Turn to 75998 for Fluoro

If the surgeon uses fluoroscopic guidance, report +75998 (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]).

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.

Note, also, that 75998 includes "Any contrast injection through the access site (via needle, catheter or sheath) for venographic evaluation and mapping of appropriate path," CPT Changes 2004 says.

Remember 2 Things Before Billing

Before reporting either 76937 or 75998, keep in mind these two things:

1. Only claim ultrasound or fluoroscopic guidance if the same physician reports both the vascular access procedure and the imaging procedure.
 
2. Remember that if the surgeon provides interpretation and report in the facility setting, you must append modifier -26 (Professional component) to the ultrasound or fluoroscopy code. The facility will bill separately for use of its equipment.