Wiki Port-a-cath and Fluoroscopic confirmation

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gabetteyoung@yahoo.com

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Good Afternoon!

Hope someone can point me in the right direction. My surgeon placed a port-a-cath with fluoroscopic and US guidance - I've got 36561, 77001 and 76937. The radiology department added 71045 because the radiologist performed a chest x-ray to confirm placement of the catheter. My understanding is that it would be incorrect to code the chest x-ray separately if the surgeon had performed it to confirm placement of the catheter tip. However, since the radiologist performed the x-ray are we able to charge for that as well? Would you use the XP modifier?

Thanks!
 
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gabetteyoung@yahoo.com said:
Good Afternoon!

Hope someone can point me in the right direction. My surgeon placed a port-a-cath with fluoroscopic and US guidance - I've got 36561, 77001 and 76937. The radiology department added 71045 because the radiologist performed a chest x-ray to confirm placement of the catheter. My understanding is that it would be incorrect to code the chest x-ray separately if the surgeon had performed it to confirm placement of the catheter tip. However, since the radiologist performed the x-ray are we able to charge for that as well? Would you use the XP modifier?

Thanks!
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Per NCCI MCR 01/01/22 so no shouldn't be charged the xray
9. When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly, when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32550, 32551, 32554, 32555), or insertion of a central flow directed catheter procedure (e.g., Swan-Ganz) (CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and the chest radiologic examination (e.g., CPT codes 71045, 71046) shall not be reported separately.

 
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nickelclaw said:
Per NCCI MCR 01/01/22 so no shouldn't be charged the xray
9. When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly, when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32550, 32551, 32554, 32555), or insertion of a central flow directed catheter procedure (e.g., Swan-Ganz) (CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and the chest radiologic examination (e.g., CPT codes 71045, 71046) shall not be reported separately.

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Thank you for your reply - again! I know this isn't the first time you've been kind enough to help me out. I really appreciate it!
 
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Great advice by @nickelclaw above. I'll just add when my when my surgeons place ivPAC, they use fluoro only and not u/s guidance. If they did use u/s guidance described by 76937, then it seems appropriate.
Before the provider prepares the site for needle puncture; she uses ultrasound to choose the best site by evaluating the vessels for size, depth, course, surrounding structures, and any adjacent deviations from the norm. She then assesses a chosen vessel for patency, meaning that it is open and unobstructed, and looks for any other anatomic issues. The provider documents the sites she examines. Once the provider finalizes her selection, the patient is appropriated prepped and anesthetized. She places the probe in a sterile cover or sheath and uses ultrasound to determine the depth of the center of the intended vessel. She then visualizes the depression of the skin on the ultrasound monitor directly over the target vessel as the tip of the needle begins to penetrate the skin. She advances the needle in small increments checking the ultrasound screen to ensure she is maintaining the proper needle trajectory, or path. Once she passes the needle into the vessel, the provider uses ultrasound to confirm placement and to ensure it is not visible in adjacent vessels, and she records this position. The provider places a guide wire, dilator, or line next, and ultrasound confirms their position within the vein to ensure proper placement. The provider includes the permanent recordings and a description of the guided access process in the final procedural report.

Don't forget since the surgeon does not own the fluoro or ultrasound equipment, mod -26.
 
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csperoni said:
Great advice by @nickelclaw above. I'll just add when my when my surgeons place ivPAC, they use fluoro only and not u/s guidance. If they did use u/s guidance described by 76937, then it seems appropriate.
Before the provider prepares the site for needle puncture; she uses ultrasound to choose the best site by evaluating the vessels for size, depth, course, surrounding structures, and any adjacent deviations from the norm. She then assesses a chosen vessel for patency, meaning that it is open and unobstructed, and looks for any other anatomic issues. The provider documents the sites she examines. Once the provider finalizes her selection, the patient is appropriated prepped and anesthetized. She places the probe in a sterile cover or sheath and uses ultrasound to determine the depth of the center of the intended vessel. She then visualizes the depression of the skin on the ultrasound monitor directly over the target vessel as the tip of the needle begins to penetrate the skin. She advances the needle in small increments checking the ultrasound screen to ensure she is maintaining the proper needle trajectory, or path. Once she passes the needle into the vessel, the provider uses ultrasound to confirm placement and to ensure it is not visible in adjacent vessels, and she records this position. The provider places a guide wire, dilator, or line next, and ultrasound confirms their position within the vein to ensure proper placement. The provider includes the permanent recordings and a description of the guided access process in the final procedural report.

Don't forget since the surgeon does not own the fluoro or ultrasound equipment, mod -26.
Click to expand...
Thanks for such a great and thorough reply!
 
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