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36514 and 36516 with modifier -26

Loni Posted Wed 13th of July, 2016 18:05:20 PM
I have some seemingly conflicting information and would appreciate clarification on the usage of CPT code 36514 and 36516 when billed with modifier -26. Below is an excerpt from CPT Assistant: CPT® Assistant. September 2009; Volume 19: Issue 9 "Although a physician is neither expected to personally operate the apheresis instrument (a nurse or other allied health professional typically performs this function), nor remain continuously present during the entire procedure (which can take over 4 hours to complete), the physician is expected to be on the facility premises throughout the procedure, available to respond to emergencies, and to periodically assess the patient as described above in order to bill supervision of this service (using a modifier 26)." There is no fee for modifier -26 with 36516 and the PC/TC indicator is "0". However, the code description for 36516 indicates for professional services, to use modifier -26. Please answer: Which is correct, to use or not to use -26? Does the same apply to CPT code 36514? Can 36514 be billed with 99233? Thank you!
SuperCoder Answered Thu 14th of July, 2016 06:41:24 AM
Thanks for your question. Please find answer to your query: 1) Though CPT manual says that you may use modifier 26 with 36516 but as per CMS, you cannot append modifier 26 or TC with 36516. We would recommend that you should not append modifier 26 with this code. 2) You cannot append modifier 26 with 36514. 3) There is CCI edit between 36514 and 99233 but a modifier is allowed. So please make sure if your documentation supports usage of modifier, then you may bill these two codes together with modifier appended to 99233 being the column 2 code. Thanks.

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