Arterial Line: Radial Approach

CPT 36620
Approach Ultrasound Guided
Add-on / Variant CPTs
  • 76937 — Ultrasound guidance for vascular access (if used)
Preoperative Diagnosis:

Need for continuous arterial pressure monitoring / [indication: hemodynamic instability / vasopressor titration / frequent ABGs / anticipated major surgery]

Postoperative Diagnosis:

Same

Procedure Performed:

Right radial arterial line placement

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Nurse/tech name]

Anesthesia:

Local: [X] mL 1% lidocaine without epinephrine

Indications:

The patient is a [age]-year-old [male/female] with a history of [indication] requiring continuous arterial pressure monitoring for [hemodynamic instability / vasopressor titration / frequent arterial blood gas sampling]. The risks, benefits, and alternatives of the procedure were discussed with the patient [or patient's surrogate], and informed consent was obtained.

Findings:

Modified Allen test was performed confirming adequate collateral ulnar circulation to the right hand with color return within [<5] seconds. The radial artery was palpable [or identified by ultrasound] at the right wrist. Arterial waveform was confirmed on the bedside monitor following catheter placement.

Description of Procedure:

The patient's right wrist was positioned in extension over a rolled towel and secured with tape. A modified Allen test was performed: the radial and ulnar arteries were occluded simultaneously, the hand was exsanguinated by clenching, and ulnar pressure was released. Color returned to the palm within [<5] seconds, confirming adequate collateral circulation.

The right wrist was prepped with ChloraPrep and draped in sterile fashion. Sterile gloves were worn. The skin and subcutaneous tissue overlying the radial artery were infiltrated with [X] mL of 1% lidocaine, taking care to avoid intraarterial injection.

The radial artery was [palpated / identified by ultrasound in transverse plane]. A [20-gauge] arterial catheter-over-needle was advanced at a 30–45 degree angle to the skin in the direction of arterial pulsation with [or without] ultrasound guidance. Arterial blood return was confirmed by pulsatile flash in the hub. The catheter was advanced over the needle into the arterial lumen using the over-the-wire or catheter-over-needle technique. The needle was removed. Pulsatile arterial blood flow was confirmed.

The catheter was connected to the pressurized arterial line tubing. A sharp arterial waveform was confirmed on the bedside monitor. The transducer was zeroed to the phlebostatic axis. The catheter was secured to the skin with a stat-lock or suture and a transparent sterile dressing was applied.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient tolerated the procedure well. Continuous arterial pressure monitoring was initiated. Distal hand perfusion was assessed and confirmed intact following the procedure.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Need for continuous arterial pressure monitoring: ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right radial arterial line placement
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Local: *** mL 1% lidocaine without epinephrine

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX requiring continuous arterial monitoring for ***. Risks and benefits discussed, consent obtained.

FINDINGS: Modified Allen test confirmed adequate ulnar collateral flow (color return <*** seconds). Arterial waveform confirmed on monitor after placement.

PROCEDURE:
Right wrist positioned in extension over rolled towel. Modified Allen test performed. Adequate collateral ulnar circulation confirmed. Wrist prepped and draped in sterile fashion.

Radial artery identified by [palpation / ultrasound]. Skin anesthetized with *** mL 1% lidocaine. A 20-gauge arterial catheter-over-needle advanced at 30–45 degrees with pulsatile blood return in hub. Catheter advanced over needle into arterial lumen. Connected to pressurized tubing. Sharp arterial waveform confirmed on monitor. Transducer zeroed to phlebostatic axis. Catheter secured, sterile dressing applied.

Distal perfusion confirmed intact post-procedure.

COMPLICATIONS: None
EBL: Minimal
DISPOSITION: Continuous arterial monitoring initiated, patient monitored in stable condition.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Failed Allen Test: Ulnar Approach

Modified Allen test demonstrated delayed color return >5 seconds, suggesting inadequate collateral ulnar circulation. To avoid risk of hand ischemia, the right ulnar artery was accessed instead at the ulnar aspect of the wrist using the same technique. Alternatively, the contralateral radial artery or femoral artery was used.

Femoral Arterial Line

Given [inability to access radial artery / bilateral radial access failure / hemodynamic instability requiring larger vessel], the right common femoral artery was accessed. The right groin was prepped and draped. The femoral artery was palpated medial to the femoral nerve and lateral to the femoral vein and accessed with a [20-gauge] arterial catheter at a 45-degree angle with pulsatile blood return. The catheter was connected to pressurized tubing and waveform confirmed. Catheter secured with suture and sterile dressing applied. Distal pulses were confirmed following placement.

Charting Tips
  • Always document the modified Allen test result explicitly. State the time to color return (<5 seconds = adequate). This is the primary medicolegal protection if hand ischemia occurs postoperatively.
  • Document distal hand perfusion assessment after the procedure (capillary refill, color, sensation). Hand ischemia is the most feared complication and documentation of a normal post-procedure exam is critical.
  • If ultrasound guidance is used and you wish to bill 76937, document real-time visualization of needle entry into the arterial lumen and save an image in the chart.
Billing Tips
  • Bill 36620 for percutaneous arterial catheter placement (0.98 wRVU, 0-day global). This covers radial, brachial, and femoral arterial lines — site does not change the code.
  • 0-day global: no bundled postoperative period. A separate E/M can be billed the same day if a significant, separately identifiable service is documented.
  • Arterial line placement is frequently bundled by payers when billed on the same day as a major surgical procedure. In the ICU/bedside setting it is separately billable. Document the clinical indication (hemodynamic monitoring, frequent ABGs) explicitly.
  • Ultrasound guidance (76942) is separately billable when used and documented with real-time imaging and a permanent record. Increasingly expected for non-radial sites. Document if used.
  • Daily management of an arterial line does not generate a separate CPT. Ongoing monitoring is captured in the critical care or E/M billing for that encounter.