Dr. Smith uses ultrasound for placement of central lines. He visualizes the internal jugular vein and takes a picture. Then using a skin marking pen, he pinpoints the exact location he will penetrate. He sets the probe down and successfully cannulates the vessel using his identified landmark. His documentation includes medical necessity, interpretation, and images before cannulationHe has satisfied all requirements to bill for a central venous line with ultrasound guidance. True or False?
False. This question differentiates between static and dynamic central line insertion, and the need for using real-time visualization during the proceure. In 2004 CPT designated a new code specifically for central venous access with ultrasound guidance (76937). The current CPT description is:“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.“There are several unique aspects of the central venous and peripheral vascular access with ultrasound guidance code of which users must be aware. The first is that the code is intended for use only when the ultrasound is used with the “dynamic” technique, as opposed to the “static” technique which is not considered a reimbursable service.The static technique utilizes the ultrasound to identify the vessel, but is not used during line placement. In the dynamic technique the physician uses the ultrasound throughout the procedure from initial identification of the vessel through direct visualization of the needle entering the vessel. A recorded image of the procedure is required for coding.When coding a central line placement under direct dynamic visualization with ultrasound it is appropriate to code 76937 for vascular ultrasound guidance and 36556 for the adult central venous line placement.access is a single thermal print of the angiocatheter needle in the vessel obtainedwhile the procedure is occurring. A cineloop, foot pedal, DVD recorder, or anassistant is helpful in obtaining this imageAn example of adequate image documentation for vascular access is a single thermal print of the angiocatheter needle in the vessel obtainedwhile the procedure is occurring. A cineloop, foot pedal, DVD recorder, or an assistant is helpful in obtaining this image Reference:1) Ultrasound FAQs. ACEP Practice Resources. http://www3.acep.org/practres.aspx?id=30502 Accessed 1/12/10.2) ULTRASOUND CODING AND REIMBURSEMENT DOCUMENT 2009 EMERGENCY ULTRASOUND SECTION, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS http://www.acep.org/workarea/downloadasset.aspx?id=33280 Accessed 1/28/10. Clinical Bottom LineWhen doing ultrasound guided central lines, document indication, what you see, and record an image or video of the needle in the vein.