A colleague and I are trying to figure out the best way to think about imaging guidance versus ultrasound guidance (in this case for PICC lines), but overall. (Neither of us are radiological intervention coders).
If we are coding 36573 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older; are we talking about actual imaging pictures? Our organization does not store images for this purpose.
So in that case, would we bill for 36569 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older?
I guess the big question here for us is, what is the actual difference between the term imaging guidance versus ultrasound guidance?
Imaging guidance means any kind of imaging guidance used, ultrasound, fluoroscopy, CT. In order to bill for imaging guidance you must have a permanent image saved. The procedure report must describe the use of the imaging guidance, and what was seen.
- Ultrasound is considered imaging guidance
- You may only bill the code with imaging guidance if you have a permanent image saved and the report describes the use of the imaging in the procedure.
- According to CPT®, this requires “image documentation and radiological supervision, interpretation, and report services require separate interpretation.” The intra-procedural imaging requires a separate paragraph in the procedure note.
Yes, bill the code that does not include imaging guidance if there is not a permanent image and a report.
There are now many services that have distinct CPT® codes, when performed with or without imaging guidance. Some, such as fine needle aspiration codes added in 2019, define the type of imaging guidance. If there are not distinct codes for the type of guidance, any imaging guidance is included when the code says “with imaging guidance.”