Ask Dr. Z

In the 2017 edition of the Interventional Radiology Coding Reference, example 2 in the "Vascular Access Device Placement" section of chapter 7 states: "Patient presents for central catheter. Ultrasound is used to determine suitability of the jugular veins. The right jugular vein is determined to be too tortuous to use. The left jugular is suitable for the placement. Ultrasound is used as guidance for needle placement (76937). Hard copy images (permanent recording) and reporting are documented. The non-tunneled central venous catheter is placed without difficulty and secured with suture (36556). After catheter manipulation and injection of contrast, confirmation of tip placement in the superior vena cava (77001) is documented on a stored image." In this example, how do you know that tip placement was confirmed by fluoroscopy? In this same section you state, "Some catheters may be placed without any guidance. The use of these guidance codes requires specific documentation to support utilization of the access guidance codes." If they do not state fluoroscopy was used, how can you code 77001?