A: No, the ultrasound guidance clarification provided in CPT 2005 does not require that the radiologist state within the report that "permanent images are stored." The guidelines state "Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized." According to these guidelines, the radiologist is required to dictate a statement about the localization process, eg, ultrasound guidance was used for needle placement, NOT that permanent images are stored. These "permanent images" should be retrievable in the event of a practice audit.
Note that the CPT® descriptor for ultrasound guidance used during vascular access (code 76937) specifically lists the requirements for using this code. The descriptor notes that this code requires ultrasound evaluation of the potential access sites, documentation of selected vessel patency, and concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting.
All radiologists should follow CPT® guidelines, and coders should make sure the radiologists are informed of the guidelines. While some radiologists may choose to dictate that permanent images were obtained, it is not required by CPT® coding guidelines. As noted previously in this newsletter, original source documentation (AMA, CMS, CDC, specialty society publications, etc.) should be used when determining what is or is not appropriate coding.