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October 29, 2012

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

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