Wiki PICC Insertion with US Guidance

eweber16

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Hello,

Per the CPT Book, documentation of US guidance for PICC placement must include the following:

1. Evaluation of the potential puncture sites
2. Patency of the entry vein
3. Real-time ultrasound visualization of the needle entry into the vein

However, CPT Assistant states that the following should be documented when US guidance is done:

1. Evaluation of the potential puncture sites
2. Patency of the entry vein
3. Real-time ultrasound visualization of the needle entry into the vein
4. Image documentation (representative images from all modalities used are stored to patient's permanent record).

My questions are:

1. Do we need the actual Ultrasound images in our documentation to report 36573 (PICC line insertion w/imaging guidance)?
2. If images ARE needed, and they are NOT included in the patient's medical records, BUT, we do have all other documentation requirements met, do we report 36569 (PICC line insertion w/o imaging guidance), or can we still use 36573?

Thank you in advance for your input.
 
U/S guidance is part of the Picc Line and cannot be billed with 36753.
HTH,
Jim Pawloski, CIRCC

Hi, Jim-

Thank you for your response. I understand that the US guidance is part of 36573.

My questions are:
1. Are the US images required documentation in order to report 36573?
2. If the images ARE required documentation, and we don't have them, but we have documented all other required areas, how do we report this: 36569, or 36573? Of note, we would already be reporting 36573 with modifier 52 because the staff that is inserting the PICC line will not be verifying the cath-tip placement.

Thank you,

Erin
 
Hi Erin,

Yes, the US images are required. If this procedure was done recently, the images may still be saved in the PACS system or on the US machine itself, but just didn't get attached to the other records in your facilities' EMR system. If the tech or Dr. didn't save the images while they were scanning, then they still need to know so that they remember to save them in the future. This happens pretty easily. I know because I was an US tech in my past life :)
HTH,

Carol
 
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