Coding 76937, Ultrasound Guidance for Vascular Access

CPT code 76937 is defined as “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 (List separately in addition to code for primary procedure). When ultrasound guidance is used for assistance with vascular access, as seen in the CPT description above, it must include all of the following:

1. Ultrasound must be used to evaluate potential access sites.
2. The dictated report must include documentation of the patency of the vein selected for entry.
   1. Examples: Documentation such as patent, narrowed, or tortuous vein(s).
3. Ultrasound must be used for real-time visualization of vascular entry.
   1. It is not appropriate to code 76937 if the vessel is seen by ultrasound and marked, but ultrasound is not used to guide the needle entry.
4. There must be documentation of the localization process in the medical record.
5. There must be permanent recordings (image(s)) of the chosen vein.
   1. If the interpreting physician does not include documentation of permanent image recording in the procedure report, copies of images must be provided for each account coded or audited.

CPT code 76937 may be used for any vascular access, whether it is related to a central venous access placement or not. Some procedures bundle code 76937, such as PICC line, IVC filter, intravascular foreign body retrieval, and TIPS procedures. Cardiac and electrophysiology procedures such as pacemakers and ICDs bundle ultrasound guidance (76937) per the NCCI Manual. Documentation of ultrasound guidance (bundled) for PICC line placement must still follow CPT guidelines for 76937. The same applies to fluoroscopic guidance for PICC. Use of a guidance system (e.g.: Sherlock 3CG®) to confirm catheter tip location does not qualify as image guidance. If both fluoroscopic guidance and ultrasound guidance are used for central venous catheters and device placement and are documented appropriately, they may both be coded.