Ashley Posted Wed 19th of June, 2019 18:09:54 PM
We are interested in determining the correct and fair coding in an ASC setting when the MD performs an angiogram in the peripheral dialysis circuit (36901) and then places a stent in the central dialysis segment or performs and angioplasty in the central dialysis segment. It is our understanding that in the upper extremity, the peripheral segment extends up to and includes the axillary vein and entire cephalic vein. The central segment includes the subclavian and innominate veins through the superior vena cava. There are instances that it is best for the patient to only perform an angioplasty or a stent placement in the central segment.
In an ASC setting, due to the effect of ‘packaging policies’ by CMS, the 36907 (Central Vein PTA) or the 36908 (Central Vein Stent), if performed in the ASC setting would not receive any reimbursement. Are we interpreting this correctly or are there other codes that we should be billing in an ASC if the physician is performing an angiogram of the dialysis circuit, determines the peripheral segment is fine but needs to stent or angioplasty the innominate vein, as an example, that is our understanding is in the central circuit.
A stent deployed in the central dialysis circuit costs between $1,500-$3,000 each. To receive no reimbursement for this in the ASC setting vs the office based setting makes no sense to us. Please explain how we should be coding this.
SuperCoder Answered Thu 20th of June, 2019 10:40:36 AM
As per CMS guidelines, the ASC fee schedule shows the status indicator for CPT 36907 and 36908 as “N” which represents “Services that are incidental, with payment packaged into another service”. Because of this, CPT code 36907 and 36908 are not separately reimbursable.
Unfortunately there is nothing much we can do here since this data is provided by CMS. CMS consideres both of these codes as inclusive services in other major procedures performed along with these procedures. We do understand that there would be loss of reimbursement but there is nothing much we can do here since CMS has the last word on this and we will have to wait and watch till CMS comes up with any changes in future.
Ashley Posted Fri 21st of June, 2019 09:43:39 AM
Are there HCPCS codes that we should be using instead or addtionally that relate to these services and will pay in an ASC setting(POS24)?
SuperCoder Answered Mon 24th of June, 2019 10:55:20 AM
Thanks for your query!,
There is no specific HCPCS code that you can bill for these services in an ASC setting.