Wiki 76937 Denials

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KoBee

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Our billing department is getting denials for 76937 stating it needs a primary procedure and I have been unable to find a list of some sort that is allowed with 76937, is anyone else having these issues and any recommendations?
 
76937 is only guidance, not the procedure itself. Here is one policy on that code (CGS):

Reporting Ultrasound Guidance for Vascular Access (CPT code 76937)​


Recently, CGS has clarified with AMA/CPT services that CPT code 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 ) applies only to venous access procedures. The imaging includes pre-access assessment of venous patency and actual real time visualization of needle passage to the venous lumen.

The descriptor for CPT code 76937 includes all phases of actual guidance, documentation, and reporting required to perform this procedure. Use of CPT code 76937 requires a permanent recorded image(s) of the vascular access site to be included in the patient record as well as a documented description of the process either separately or within the procedure report.

Therefore, it is not appropriate to report CPT code 76937 for ultrasound guidance when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with non-guided puncture,. (Note: CPT code 76942 should not be reported with CPT code 76937.)

Effective immediately, the base CPT codes for this ultrasound guidance procedure will be payable only for certain venous access procedures. These are:

CPT code 36000
CPT code 36005
CPT code 36010
CPT code 36011
CPT code 36012
CPT code 36481
CPT code 36500
CPT codes 36555 - 36585
CPT code 36581

The key to appropriate code selection is documentation. Some key elements to include in the documentation for this procedure are:

  • Guidance used
  • Vein entry site
  • Tunneled vs. non-tunneled
  • Subcutaneous pump, if in place
  • Final catheter tip position
  • Patient age
 
SharonCollachi said:
76937 is only guidance, not the procedure itself. Here is one policy on that code (CGS):

Reporting Ultrasound Guidance for Vascular Access (CPT code 76937)​


Recently, CGS has clarified with AMA/CPT services that CPT code 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 ) applies only to venous access procedures. The imaging includes pre-access assessment of venous patency and actual real time visualization of needle passage to the venous lumen.

The descriptor for CPT code 76937 includes all phases of actual guidance, documentation, and reporting required to perform this procedure. Use of CPT code 76937 requires a permanent recorded image(s) of the vascular access site to be included in the patient record as well as a documented description of the process either separately or within the procedure report.

Therefore, it is not appropriate to report CPT code 76937 for ultrasound guidance when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with non-guided puncture,. (Note: CPT code 76942 should not be reported with CPT code 76937.)

Effective immediately, the base CPT codes for this ultrasound guidance procedure will be payable only for certain venous access procedures. These are:

CPT code 36000
CPT code 36005
CPT code 36010
CPT code 36011
CPT code 36012
CPT code 36481
CPT code 36500
CPT codes 36555 - 36585
CPT code 36581

The key to appropriate code selection is documentation. Some key elements to include in the documentation for this procedure are:

  • Guidance used
  • Vein entry site
  • Tunneled vs. non-tunneled
  • Subcutaneous pump, if in place
  • Final catheter tip position
  • Patient age
Click to expand...
I have cardiology providers who use 76937 with heart catherization's or for EP procedures, so would that be inappropriate based on the information you stated above with allowed procedure list?
 
KoBee said:
I have cardiology providers who use 76937 with heart catherization's or for EP procedures, so would that be inappropriate based on the information you stated above with allowed procedure list?
Click to expand...


It looks like the the access is included with heart cath and not reported separately (but this is totally NOT my area):

Following Services are included in cardiac catheterization procedures​


  • Local anesthesia and/or sedation
  • Introduction, positioning, and repositioning of catheters
  • Recording of intracardiac and intravascular pressures
  • Obtaining blood samples for blood gases
  • Cardiac output measurements
  • Monitoring service which including oxygen saturation, ECCS, arterial pressures
  • Vascular catheter and line removal
  • Final Evaluation
  • Written Report
 
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