CPT Code 92900 B: Billing and Documentation Guidelines

Continuous arterial blood pressure monitoring is a service for unstable patients that provides real-time physiological data. Understanding how this service is documented and billed is necessary for reimbursement. The process involves a code for inserting the monitoring line, while the monitoring itself is included in other services.

What is Continuous Arterial Pressure Monitoring?

This service provides continuous, real-time blood pressure data, which is different from routine checks performed with an inflatable cuff. The procedure involves inserting an indwelling arterial catheter—a thin tube placed directly into an artery, such as the radial artery in the wrist.

This catheter is connected to a pressure transducer, which converts the arterial pressure wave into an electrical signal. This signal is then displayed on a bedside monitor as a continuous waveform and a digital numeric value, offering an uninterrupted view of the patient’s hemodynamic status.

This monitoring is reserved for patients whose condition is unstable enough that intermittent measurements would be insufficient. The data allows for the immediate detection of rapid changes in blood pressure to guide medical interventions.

When is Continuous Monitoring Medically Necessary?

Continuous arterial pressure monitoring is justified only in high-acuity clinical environments where a patient’s condition necessitates it. Common settings include the Intensive Care Unit (ICU), the Operating Room (OR), and a Cardiac Catheterization Lab. Medical necessity means the patient’s state must warrant this level of observation.

Conditions that require this monitoring include:

• Severe hemodynamic instability, such as in septic shock or following major trauma.
• Hypertensive emergencies where blood pressure must be lowered in a controlled manner with intravenous medications.
• The administration of powerful vasoactive drugs that directly affect blood pressure.
• During and after major surgical procedures, like cardiovascular surgeries or other complex operations where large fluid shifts or blood loss are anticipated.

Billing and Documentation Guidelines

Billing for arterial pressure monitoring requires proper documentation and an understanding of how different components are reported.

The procedure to insert the arterial catheter is a distinct and separately billable service. The provider who places the line reports CPT code 36620, which covers the percutaneous insertion of an arterial catheter for monitoring or transfusion.

The ongoing monitoring service is not billed with a separate CPT code. The work is considered bundled into the payment for high-level services provided in that setting, such as critical care E/M codes, or is reimbursed through the facility’s per-diem rate for the ICU bed.

Documentation in the patient’s medical record is the foundation for a valid claim. The record must contain a physician’s order for the arterial line and proof that monitoring was performed. This is shown in nursing flowsheets or ICU records with frequent documentation of the arterial pressure readings.