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DX for Venous Acces needed/hypotensive and ultrasound

  1. Default DX for Venous Acces needed/hypotensive and ultrasound
    Medical Coding Books
    Part of my question was answered which was greatly appreciated, However, I am still trying to figure out what would be the correct DX and Radiology code. (77001 -26or 76937-26) see the following question:

    Also I wanted to know how do I know when to code the ultrasound-76937 or the Fluroscopic 77001? Usually, the note will say fluroscopic was used, however, on this particualr one, it says sonosite ultrasound. I was looking at the chart you sent me, and I saw the ultrasound code 76937. So what in this particular report, indicates it is a 77001 vs a 76937?

    Indication: Hypotensive. Venous access needed for vasopressor infusion
    ( what dx would I use for that?)

    There was exaggerated distention of the external juglar and veins of the head and neck. Using the sonosite ultrasound, the right IJ was easily identified and the carotid artery was easily identified. The patient was then prepped and draped in the usual sterile fashion. Using appropriate sterile technique, gowns, gloves, mask and cap, the patient was positioned properly. The right internal juglar vein was easily entered using the sonosite ultrasound. A wire was passed through the needle and into position. The needle was removed. The wire could not be advanced all the way through the SVC and met persistent obstruction at approximately 9 cm from the skin. A small incision was made and a dilator passed over the wire. A triple lumen central venous line was then passed over the wire through the IJ. It was advanced to 9cm and, at that point, could not be adbvanced further. The wire was then removed.Again, attempts were made without success in advancing the triple lumen cath any further than 9cm at the skin.There was good blood return from all ports. The cath was easily flushed with saline. The cath was then secured in place at several sites. The vasopressors were instilled through the distal port and instructions given to maintain vasopressors via distal port only.

    Thanks so much!

  2. #2
    I would use hypotension as the dx. I know when my docs put catheters in for "need for venous access," a lot of the time, the pt is also septic. As to your other question, I'm not sure what a sonosite ultrasound is...if I were you, I would ask the physician what the difference between the fluoro machine and the sonosite machine are and what the difference between a regular sono and a sonosite sono is. Sounds to me like the ultrasound code would be more appropriate.
    Chrissy, CPC

  3. #3
    My surgeon uses SiteRite Ultrasound (76937) and/or fluoroscopy (77001). He will state in his operative note which one(s) he is using. He is ususally using the SiteRite to find the vein and then the fluoroscopy to check the catheter at the end of the procedure. When he does this, I bill both codes.

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