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CPT code 36000 - Intro of needle or intracath, vein. Nonselec cath place vein

Kelly Posted Fri 28th of December, 2018 15:50:11 PM
How can I explain to new coders when to use 36000 instead of the infusion and injection codes. Is 36000 appropriate to use for a maintenance IV in the ED? Some believe since part of CPT 36000's description states 'needle' that it can be reported in this manner instead of when the physician needs to place a catheter for a non-selective cath. Can you please site references with your answer? Thank you!
SuperCoder Answered Mon 31st of December, 2018 07:00:27 AM

Hi Kelly,

 

Thanks for your question.

 

As per NCCI correct coding guidelines by CMS, “most HCPCS/CPT code defined procedures include services that are integral to them. Some of these integral services have specific CPT codes for reporting the service when not performed as an integral part of another procedure. (For example, CPT code 36000 (introduction of needle or intracatheter into a vein) is integral to all nuclear medicine procedures requiring injection of a radiopharmaceutical into a vein.”

 

“CPT code 36000 is not separately reportable with these types of nuclear medicine procedures. However, CPT code 36000 may be reported alone if the only service provided is the introduction of a needle into a vein.) Other integral services do not have specific CPT codes. (For example, wound irrigation is integral to the treatment of all wounds and does not have a HCPCS/CPT code.) Services integral to HCPCS/CPT code defined procedures are included in those procedures based on the standards of medical/surgical practice. It is inappropriate to separately report services that are integral to another procedure with that procedure.”

 

Tip: Code 36000 is an intravenous code used during any procedure in which a needle or catheter is inserted into the vascular system. This may be in order to apply anesthesia, introduce other needles or catheters, or fluoroscopy.

 

For example, if a provider performs a needle insertion, reported as 36000, in the morning, and then sees the same patient later in the day for critical care, you can report 36000 again separately using modifier 59, Distinct procedural service. Be sure to include documentation to show how these services are separate and distinct.

 

Please feel free to write if you have any question.

 

Thanks

Kelly Posted Wed 02nd of January, 2019 09:27:51 AM
Thank you. Can you address why CPT 36000 would not be used for a maintenance IV, for example, in the ED to get fluids running that are not considered hydration meds?
SuperCoder Answered Thu 03rd of January, 2019 03:09:57 AM

Code descriptor of CPT code 36000 says “Introduction of needle or intracatheter, vein”, which means this code should only be reported if needle or catheter is introduced into a vein.

 

Moreover, CMS designates the status of this code as “B” in the Medicare Physician Fee Schedule (MPFS). This means payment for these services is always bundled into the payment for other services. Hence this code can only be paid if no other procedure is performed along with this.

 

Please feel free to write if you have any question.

 

Thanks

Kelly Posted Thu 03rd of January, 2019 16:29:12 PM
Asking the question in a different way. Both CPT codes indicate they use a "needle..." inserted into a vein, to introduce "...medications..." When do you use CPT 36000 instead of 96360? 36000- The provider introduces a needle or intra-catheter into a vein to administer or withdraw fluids or other substances. (Tip: This may be in order to apply anesthesia, introduce other needles or catheters, or fluoroscopy). 96360 - Intravenous infusion, hydration initial, 31 minutes to 1 hour
SuperCoder Answered Fri 04th of January, 2019 07:14:06 AM

Code 96360 represents IV hydration infusion. It includes both insertion of needle or catheter and infusion of the hydration solution. It is a time-based code for supplementation of fluid and electrolytes for 31 minutes to one hour to treat severe cases of dehydration.

 

CPT code 36000 may be reported alone if the only service provided is the introduction of a needle into a vein without any infusion.

 

If sole purpose of fluid administration is to maintain patency of an access device, the infusion is neither diagnostic nor therapeutic and should not be reported separately.

 

Hope it helps.

 

Thanks.

Kelly Posted Mon 07th of January, 2019 10:04:12 AM
This last answer is what I was looking for--thank you for the clarification!
SuperCoder Answered Tue 08th of January, 2019 00:23:19 AM

Thank you, happy to help.

Kelly Posted Mon 23rd of September, 2019 11:49:41 AM
Can 36000 be reported for the hospital side when it is administered by a PICC nurse or can it only be reported when it is inserted by a physician?
SuperCoder Answered Tue 24th of September, 2019 01:05:45 AM

Thank you for the question, it is requested to post this query in a new thread as it is already crossed the timeline of six months.

 

Thank you.

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