Ask Dr. Z

Would it ever be appropriate for a PICC line placement done by an RN in an outpatient clinic setting to be reported with CPT 36573 rather than CPT 36569 if the RN uses ultrasound? In order to consider the procedure to have been performed with US guidance, does there need to be a report of the US guidance documented by a radiologist? Would a copy of an image of the US guidance added to the medical record support the documentation required for CPT 36573? Would a narrative note by the RN of the use of US guidance be sufficient? The current documentation is done electronically, and the only indication of the use of the ultrasound device is one line that shows as “Ultrasound guidance used = Y.”

The facility PICC team is trying to determine if the outpatient PICC line placement procedures would qualify for reporting of CPT 36573 instead of CPT 36569, and if so, what specific documentation must be in the medical record for the coder to be able to assign the correct CPT code.