We recently added the CPT charge 76936 for Ultrasound Guided
Pseudoaneurysm Repair as one of our charges; we actually do not provide
direct compression-  what we do is have the patient brought to the cath lab
holding area, they handle all the conscious sedation and monitoring of the
patient, we identify the pseudoaneurysm and then the attending MD comes in
and applies a C-clamp or fem-stop to compress the pseudoaneurysm. We then
return on a rotation of every 45 minutes to 1 hour. The physician undoes the
clamp, we check the pseudoaneurysm for progression of thrombosis and the
physician re-applies the clamp to compress the pseudoaneurysm. We do this
procedure a maximum of 4 hours, if it is not thrombosed within the time
frame, the physician decides if it should be surgically repaired or
discharge the patient and re-check it 2- 3 weeks later for spontaneous
thrombosis.

     THIS IS WHAT IS BEING SUGGESTED:   The cath lab has decided that since
they monitor the patient, provide the space, do all the conscious sedation,
and the physician applies the clamp for compression they should use the CPT
charge 76936. The Vascular Lab should use CPT code  93925 Arterial Duplex
Scan-Unilateral and repeat the charge depending on how many times we return
to check the pseudoaneurysm. ( Maximum 4 return trips, minimum probably 2:
the initial clamping and then one follow up trip ).

    HERE ARE MY QUESTIONS: 1. Is the CPT code 76936 a charge that should be
used if only actual compression by the ultrasound probe is applied?
                                                 2. Could the Vascular LAB
use this code as their charge for the repeated studies that are being done
to check for pseudoaneurysm compression and thrombosis?
                                                 3.  Should the Vascular Lab
charge CPT code 93925 one time despite how many studies are being done. (
This is our current practice).
                                                 3.  Should the Cath Lab be
using this charge to generate revenue to their dept for this procedure?

   I will be interested in getting other opinions.


Respectfully,

Megan Hodge, RN RVT
Clinical Supervisor
Vascular Diagnostic Laboratory
The Methodist Hospital, Houston,TX
Voice: 713-790-5987
Fax: 713-790-4965
E-mail: [log in to unmask]