Question: If the physician documents the use of ultrasound but does not provide enough documentation to meet the CPT requirements of “documentation of evaluation of the potential puncture sites, patency of the entry vein, and real-time ultrasound visualization of needle entry into the vein, would it be more appropriate to assign the bundled peripherally inserted central catheters (PICC) code with a modifier 52 or assign the “without imaging” PICC code?
Answer: As of January 1, 2019, PICC placed using a guidance system that does not include imaging (eg, ultrasound, fluoroscopy) or sufficient image documentation should be reported with code 36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age or code 36569 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older.
If the PICC placement was performed with only fluoroscopic guidance, only ultrasound guidance, or both fluoroscopic and ultrasound guidance, it is appropriate to report codes 36572 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; younger than 5 years of age or 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. Documentation should include imaging guidance and final central position of the catheter.
When ultrasound guidance for PICC placement is performed, the procedure report should include documentation of evaluation of the potential access site(s), the patency of the vein entered, and real-time ultrasound visualization of needle entry into the vein; in addition, a permanent recording and reporting of the guidance must be recorded. In the circumstance of a PICC line placed with only ultrasound guidance (no fluoroscopy) and all of the documentation requirements for ultrasound guidance are not satisfied, then code 36568 or 36569 should be reported.