In the August 25 ACE Alert, we shared the NCCI Radiology Chapter 9 guidelines and mentioned we had been notified by several clients about a specific UHC policy. The policy specifically instructed that the retained image must show the final placement of the needle. Services were denied as the verbiage did not include evidence of real-time image guidance, and the image retained did not show the final placement of the central line. The payers are looking for any reason to take the money back on these ancillary services.
UHC does not look like it will be letting up on this policy. During a recent audit, it was discovered that UHC is currently scrutinizing Central Venous Access Procedures. This category of procedures includes both CVC and PICC. The basis for the denials stems from documentation not specifying the site where the tip of the catheter terminates. Codes are assigned for CVC when the entry site is the jugular, subclavian, femoral vein, or inferior vena cava and for a PICC when the entry site is the basilic, cephalic, or saphenous vein. Whether CVC or PICC, the catheter tip “must terminate in the subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena cava or the right atrium”. -CPT Guidelines for Central Venous Access Procedures
As stated before, payers are looking for a reason to deny. At least with UHC, it appears the trend is to employ an expectation where documentation includes the specific elements indicated in CPT guidelines for ancillary services. There was a very literal approach to USG for vessels, looking for documentation of vessel patency and currently requiring documentation to include the catheter tip terminus, in addition to the vessel insertion site, for Central Venous Catheters. Consider updating templates to include the tip terminus information. Doing so will better support chances for reversal of denial should this UHC policy start to affect your practice and/or if other payers begin to implement similar expectations. If you would like any help in reviewing your documentation or have any questions, we would be happy to do a focused review or provide education to your providers on the elements required for USG.
Deena Gauthier, CPC, CDEO, CANPC, CGSC