Well, it is certainly not boring in the world of healthcare compliance. One thing the observer of this domain will have learned over the years is that rules rarely remain static over a sustained period of time. Coding, billing and documentation conventions are often in flux—sometimes year over year. This dynamism may make things interesting; it can certainly keep us on our toes, but it can also be a source of frustration for those who bear the brunt of such change. And change has come for ultrasound guidance (USG) providers.
The Code in Question
For years now, it has been possible to get paid for utilizing USG in connection with placing invasive lines. You get reimbursed for the placement, and you receive separate payment for the USG. It used to be that this service was only payable in connection with central lines. But, beginning just a few years ago, reimbursement was extended to providers utilizing USG in connection with arterial line, as well.
The particular service we’re talking about is reflected by CPT 76937, which is an add-on code with the following descriptor:
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)
We have said before that the American Medical Association (AMA), which publishes the CPT coding manual, makes it clear that this code cannot be billed unless BOTH (a) the USG image, AND (b) the USG report are retained in the patient’s medical record. Coronis Health requires evidence of both before this charge is submitted to the payer. For the image requirement, we simply ask that you include an attestation on the charge document (typically, the anesthesia record) indicating “image retained” or verbiage to that effect, if, in fact, the USG image has been made a part of the patient’s chart. For the report requirement, we ask that you send us the report. It is the content of the report that is now becoming an issue in some quarters.
The Bone of Contention
We are receiving more correspondence back from payers relating to CPT 76937 due to a “lack of documentation of patency of the selected vessel.” Indeed, according to the assessment of our Coding Department, some auditors are now also reviewing 76937 in the provider’s report for mention of patency of the vessel. You’ll recall that the code descriptor, furnished above, does, in fact, require “documentation of selected vessel patency.”
It is also interesting that the American Academy of Professional Coders (AAPC), in a March 6, 2025 article in its Codify magazine, emphasized the following as far as the provider’s documentation elements relative to CPT 76937:
Coders need to prioritize capturing and reporting the following information:
- Documentation of the patency of the selected vessel
- Concurrent real-time US visualization of vascular needle entry into the vessel; simply documenting a pre/post image for placement is not sufficient to meet the criteria
- Permanent recording and storage of the images is required to be included in the patient record (The images must be accessible for retrieval upon request from a payor or audit scenario.)
Over five years ago, we sent out similar documentation instructions for the code in question that included the need for documenting vessel patency.
We understand that many providers may feel that the specific mentioning of vessel patency in their documentation is fairly superfluous since patency can be inferred when denoting that the invasive line placement was successful. It clearly would not be successful if the vessel was obstructed! Nevertheless, as this has become an item recently being reviewed by some payers, as well as auditors, it would behoove providers of USG services in connection with invasive line placements to include this element within their documentation.
Accordingly, if you are using a template for your USG report in connection with invasive lines, we encourage you to add verbiage involving vessel patency. Here is an example of a report template that we published over five years ago and is still applicable today:
(1) US was used to identify the ____ vessel. (2) It was assessed and patent. (3) US was used to visualize vascular needle entry into the ____ vessel. (4) The selected vessel appeared anatomically normal and (5) there were no apparent abnormal findings. (6) A permanent ultrasound image was saved in the patient's record.
We hope that this alert will help you in your documentation for your USG services. If you have questions about this article, please contact your account executive.