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36831 in an office setting

Ashley Posted Wed 09th of December, 2015 11:14:54 AM

In the past we have billed 36831 but I think this can be done and payable in a facility setting as they never pay for it can you confirm this see below for what was done. Any help would be great thanks.

Yesterday evening we finished a complex thrombectomy that started as a percutaneous thrombectomy, 36870, and ended up as an open thrombectomy, 36831, there were fusiform aneurysms of the cephalic vein which contained thrombus that would not macerate with the thrombectomy device, so I made two small incisions in the fistula and manually expressed the thrombus through the incisions. I have done this before and coded for both, but I don’t know if that is the correct way to code this.

SuperCoder Answered Thu 10th of December, 2015 02:54:56 AM

Hi,

This is a major surgical procedure with a global period of 90-day that can only be done in the facility setting. We cannot get reimburse for this procedure when done in the office setting.

Ashley Posted Thu 10th of December, 2015 10:42:31 AM

thanks for the conformation but why would a 90 day globe have any thing to do with it as 36870 is allow in an office setting and has a 90 day globe?

SuperCoder Answered Fri 11th of December, 2015 09:21:39 AM

As per coding guidelines when any procedure turned to the open approach, then only open procedure code need to be coded. Procedure global period are designed on the basis of prognosis of the condition. Physician takes the decision to perform the procedure at the office or facility settings on the severity basis of the condition, and insurance companies/ payers decide the payment according to the place of service. Some procedures are paid for POS office, some for facility and some for both the settings. So, it is suggestible to confirm it from payer before billing, that your performed procedure can be billed for which speciality and plan it accordingly.

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