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Guidelines for use of 36591, 36592 and J1642

Vickie Posted Mon 17th of October, 2011 20:04:20 PM

Is it correct to code these charges for collection of labs only? Can you charge for a 36591 or a 36592 and flush with heparin(J1642) with a nurse visit (99211)? If patient is receiving chemo and labs are done prior to treatment, can you charge a 36591 or 36592 and flush with heparin (J1642)? If not, can you charge for the heparin (J1642)only?

SuperCoder Answered Tue 18th of October, 2011 08:44:12 AM

Accessing of venous access devices for blood collection and/or Heparin flush are part of managing the patient and included in the appropriate E/M code.
-use 99211 for accessing and flushing of a catheter, line or port, only when the service is DISTINCT and SEPARATE from CHEMOTHERAPY administration and other E/M services.
-Oncology practices should bill the higher-level visit, 99212-99215, and consider the port flush as part of the office visit.
Hospitals billing under the Outpatient Prospective Payment System (OPPS) will continue to report “packaged” services, including both of these specimen collection codes. While code 36592 will never be separately paid in the hospital outpatient department, code 36591 is a “special packaged” code and will be reimbursed when it is the only service performed for the patient that day.
HCPCS code J1642 may also be assigned for the heparin used to perform the port flush. Individual payer guidelines will determine whether there is separate reimbursement for the heparin; it is often considered to be a supply charge rather than a drug charge.
NOTE: Although 36591 is accurate, many payers don’t want providers drawing blood from the patient’s port for convenience only. You-ll need a documented reason for medical necessity, such as being unable to access veins.
PICC note: If the patient has a PICC instead of a port, submit 36592 (Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified).

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