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Documentation of Ultrasound picture

Does anyone have any information about whether or not it is necessary to place a picture of the ultrasound picture in the patient's chart to prove that access was gained with ultrasound guidance. We currently have an intensivist working in our ICU that says that we need to place a copy of the ultrasound picture in the chart for billing reasons. Can anyone hlep me with this?

Thanks, Susan Brown RN, CRNI

Wyoming Medical Center

mary ann ferrannini
 In an inpatient setting the

 In an inpatient setting the patient is usually charged for the procedure and there is not a seperate charge for the use of the US. I have heard that in some outpatient setting there may be a seperate charge for use of the equipment and some nurses were adding a picture to the chart. I think we are almost to the point where the standard for all PICC placement will be to use an US. I personally would check with your billing department to see how it is billed and how it is reimbursed..remember most of nursing comes with the bed and the only thing chargable in many cases is the equipment and products used.

I also checked into this with

I also checked into this with our billing dept. They said in order for medicare to reinburse we had to show proof of ultrasound use. We post a pic of every ultrasound because we usually do not look up the insurance until we are done with placement and putting charges in.

P. Roberts, RN, BSN,VA-BC

Regardless of In or

Regardless of In or Out-patient procedure....all PICC insertions are documented with a copy of the ultrasound image in the patients records.

All Hospitahl or just some?

 We have a pt that has a picc line in her arm but we can find no records of one ever being put in. All her hospital records have been looked at any clue were to look?

Chris Cavanaugh
Depends on who is payor

Some payors will accept the documentation "used real time ultrasound guidence to place PICC line"  some require a photo with catheter in vein (longitudinal or sagital is easiest to see)

Many hospitals will just take the photo because it is easier than trying to remember, this payor requires a photo, this one does not.

There is  a separate CPT code for use of Ultrasound to place a central line (including PICCs)


Chris Cavanaugh, RN, BSN, CRNI, VA-BC

we were placing ultrasound image in chart

but stopped because billing compliance informed us we couldn't charge anymore unless we had a provider in the room with while the vein was being cannulated - nursing can't bill for most procedural work. 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Kathy Evans
We use ultrasound for all RN

We use ultrasound for all RN bedside PICC placements.  We also bill each patient for this use.  We place a picture of the vein in each chart because we have been told that many insurance companies will not reimburse for ultrasound use unless this is done.  We have done this for the last 7 years.


Recording patient info on the us system

Do you also enter patient information in the ultrasound system to showhis/her name on the picture itself?

Chris Cavanaugh

Reimbusement by CMS (Medicare/Medicade) changes every year,  and so you should check with your patient accounts/billing department to see what the latest rules are in your hospital.  It also varies by state, so there is not one simple answer.  Many manufacturers have reimbursement information that they can provide, you may want to check with your rep for your ultrasound machine. 



Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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