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 Reimbursement is tied to DRG for Medicare patients and to other capitated fee structures. This means that no payment is made to the hospital for procedures such as PICC insertion. Inserters may be sending "charges" through but this is not changing the amount of money being reimbursed to the hospital. But, and this is very important, the rules for critical access hospitals are different from other hospitals and I am not sure what they are now. You should work with the billing dept in your facility to get information about how a critical access hospital is reimbursed. Lynn

The CPT Code is for reporting, please check with your billing department for applicable charges.
Here is some information to help you.

This topic from CMS website.

Home> What’s New > Educational Article: Ultrasound Guidance for Vascular Access Requiring Ultrasound Evaluation of Potential Access Sites (CPT Code 76937)

Educational Article: Ultrasound Guidance for Vascular Access Requiring Ultrasound Evaluation of Potential Access Sites (CPT Code 76937)

Posted May 21, 2009 in Part B

The Contractor has recently reviewed data of claims submitted for Current Procedural Terminology (CPT) code 76937 [Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)] performed between January 1, 2008 and December 31, 2008. This data revealed the inappropriate billing of this procedure.

The CPT Assistant, December 2004, page 13 states: This imaging includes pre-access assessment of venous patency and actual real-time visualization of needle passage to the venous lumen. The descriptor for code 76937 includes all phases of actual guidance, documentation, and reporting required to perform this procedure. Use of 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, 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.

Most vascular access procedures do not require ultrasound guidance; therefore, 76937 should not be used routinely but for exceptional cases. Some examples when ultrasound guidance of vascular access procedures may be necessary are obesity, burn/scar tissue at access site, and failed multiple attempts. Documentation must show medical necessity for this procedure.

The Contractor asks that you review your current billing of CPT 76937 to ensure appropriate claims submission is in adherence to all CMS guidelines. The provider community is reminded of the importance of accurate coding and billing of services to assure appropriate payment of claims for medically necessary, covered, and correctly billed services.

To ensure appropriate utilization, ongoing data analysis will continue to monitor for aberrant provider billing.

This article can be viewed in the Medicare Coverage Database after June 1, 2009.

Home » KY& OH Part B » News& Publications » News » Reporting Ultrasound Guidance for Vascular Access (CPT code 76937)

October 29, 2012 http://www.cgsmedicare.com/partb/pubs/news/2012/1012/cope20331.html

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

Under the CMS publication (2012) below, the requirement is twofold as far as the image is concerned. “The imaging includes pre-access assessment of venous patency and actual real time visualization of needle passage to the venous lumen.” So as I read it, “real-time needle entry” is required as in this image. Note the bevel of the needle is well within the lumen of the vessel. Accessing a vein on the “long axis” is a skill that requires time and practice. On the “short axis” the image is not as clear, but you should see the vein lumen completely full, round and the bright bevel spot within the lumen.

I hope this is helpful.