The AMA released updates on Ultrasonic Guidance for Needle Placement that can effect coding and billing for anesthesia. This is an important change from the 2019 Relative Value Guide to take note of. While not specifically outlined, additional thoroughness in the medical documentation process is needed in order to be prudent.
(Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation)
Attention is increasing on the descriptor above for code 76942 which specifies that there must be an interpretation for the ultrasound along with the assurance that the ultrasound image be reproducible. Ultrasound used only to identify the anatomy is not billable.
The following from CPT Assistant defines what would NOT be billable: “…for those instances when ultrasound is utilized only to identify a vein, mark a skin entry point, and proceed with non-guided puncture, it would not be appropriate to report code 76937 for ultrasound guidance.”
No specific guidelines as to what has to be documented are provided, but the interpretation should clearly state visualization of the needle after penetration of the skin. The following excerpt from CPT® Assistant helps to outline what should be documented in an ultrasound note for a 76937 for venous access: “This imaging includes pre-access assessment of venous patency and actual real-time visualization of needle passage to the venous lumen.”
While the above guidance addresses vascular access, prudent documentation habits should dictate that the expectation would follow the same guidelines for needle guidance (76942) specific to the actual visualization of the needle after the puncture of the skin, the spread of medication, etc.
For 2019, AMA has included a list of codes in the parenthetical phrase below 76937 that lists the codes with which 76937 cannot be billed which does NOT include the 36620 (arterial line). This has been debated for some time as to whether u/s guidance should or should not be separately billed. CMS may, of course, have a different point of view, but unless the 76937/36620 combination is bundled by the National Correct Coding Initiative (NCCI), it would appear that the u/s could be billed with the appropriate documentation.
An interpretation for the ultrasound might be something as simple as:
- “Ultrasound guidance visualized the needle entering into the vessel” or
- “Ultrasound was used to identify needle positioning in close proximity to the nerve being blocked”
Some block records include the interpretation along with a statement of “image retained” to verify that the image is a part of the permanent medical record and is reproducible should the need arise. Check with your facility to verify how the image is being saved.
There are several unique aspects of the central venous and peripheral vascular access with ultrasound guidance code of which users should 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.
Physicians and other medical providers should take steps to be aware of any documentation improvement needed. Don’t let anesthesia reimbursement be negatively affected due to a lack of detail in medical documentation.
Interested in other updates that impact anesthesia reimbursement trends? Read about field avoidance here and request a copy of abeo’s Anesthesia and Pain Management Guide.