For the Week of December 5, 2016

Can we use the following CPT code for ultrasound guidance for vascular access in the heart cath lab if we have documentation and archived images?

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)

If all of the guidelines of 76937 are met, then yes it can be coded with cath lab procedures.



Has the FDA finalized its guidance on LDTs yet?

According to a report from the American Hospital Association, the U.S. Food and Drug Administration (FDA) plans to delay its final rule on laboratory developed tests (LDTs). It will, instead, wait to work with the next administration and Congress, according to multiple news reports.


How do we bill for pharmacy supplies?

There are two classifications for supplies: sterile and non-sterile, and a different revenue code must be reported for each group. Nonsterile supplies are assigned to revenue code 271, and sterile supplies are assigned to revenue code 272. There are usually no CPT or HCPCS Level II codes assigned to these revenue codes.

Most drugs are packaged into the outpatient prospective payment system (OPPS) ambulatory payment classification (APC) rate for Medicare patients and are reported with revenue code 250—general pharmacy. Some drugs require specific identification and will be paid separately under the APC system. A drug that has an associated HCPCS Level II “J” code can be reported on the claim form on separate line items with revenue code 636—drug requiring detailed coding. Depending upon the actual J code, additional reimbursement may be realized on the Medi¬care remittance advice.

Each year, when the final OPPS rule is released in November, it is important that facilities have a chargemaster analyst review the drugs and determine if the appropriate HCPCS level II “J” codes are being reported.


A patient had two different ultrasound exams (76536) completed on the same visit. One was for thyroid nodules and the other was for a lump on the patient’s jaw. Can we bill for both of these exams separately, or should we only bill as one charge?

You would report the following code only once. It includes all ultrasound imaging of the soft tissues of the head and neck.

76536 Ultrasound, soft tissues of head and neck (e.g., thyroid, parathyroid, parotid), real time with image documentation


Many people use the terms “sleep testing” and PSG interchangeable. Is this correct?

Sleep testing differs from polysomnography (PSG) in that the latter requires the presence of sleep staging, which includes a qualitative and quantitative assessment of sleep as determined by standard sleep-scoring techniques. Accordingly, at the same session, a sleep study and PSG are not reported together.

PSG requires at least one central and usually several other EEG electrodes. EEG procurement for PSG (sleep staging) differs greatly from that required for diagnostic EEG testing (i.e., acquisition speed, number of channels, etc.). Accordingly, EEG testing is not to be reported with PSG unless performed separately; the EEG tests, if rendered with a separate report, are to be reported with modifier 59 or one of the X{EPSU} modifiers, indicating that this represents a different session from the sleep study.


In regard to medical records, what does the phrase “cloning” mean?

Copying and pasting documentation from a previous visit into the current visit of a medical record is known as “cloning.” In some systems some information is automatically populated from the previous visit information. Providers who do not validate the information that is brought forward and/or just accept the information can cause tremendous headaches from several different standpoints. Information that is not relevant to that patient visit and/or is inaccurate may be used to code and bill inappropriate charges. Inaccurate or incomplete information may pose a legal issue when someone is called upon to testify about the medical record documentation in a legal proceeding.