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Medicare coverage for Proc 36600 and 36415

Amani Posted Wed 17th of July, 2013 21:16:05 PM

Those procedures were performed inpatient and the hospital billed more than 1 time for the same day of service, does Medicare cover all those 2+ charges(more than 1)? or do they only allow 1? Need documentation to support the answer please.

Thank you,
Amani

SuperCoder Answered Fri 19th of July, 2013 00:48:34 AM

Only one.Physicians may perform an arterial blood draw, which represents a far more complicated procedure than routine venipuncture. You should report this service with 36600 (Arterial puncture, withdrawal of blood for diagnosis) rather than a venipuncture code.

If a pulmonologist ordered arterial blood gas analysis to be performed during the complex pulmonary stress exercise, you would bill the blooddraw and analysis separately using 36600 (Arterial puncture, withdrawal of blood for diagnosis), 82803 (Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 [including calculated O2 saturation]) or 82805 (Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 [including calculated O2 saturation] with O2 saturation, by direct measurement, except pulse oximetry).
The CPT 36600 is included in the critical care codes.

For certain tests such as blood gases, physicians may perform an arterial blood draw, which represents a far more complicated procedure than routine venipuncture. You should report this service with 36600* (Arterial puncture, withdrawal of blood for diagnosis) rather than a venipuncture code. When it is provided by a physician, Medicare pays for arterial puncture at nearly 10 times the rate of a routine venipuncture.

Amani Posted Fri 19th of July, 2013 19:49:24 PM

Just to clarify, If the itemized statement has 3 charges for 36600 on the same date of service (inpatient) and on another itemized statement for another patient; 4 charges for venipuncture 36415, we will be only paying for ONE only and deny the rest? is that correct? where I can find Medicare regulation that support your answer? Thansk

SuperCoder Answered Fri 02nd of August, 2013 15:32:48 PM

You shouldn’t separately bill venipuncture for hospital inpatients — the service is included in the DRG rate structure.

For hospital outpatients, Medicare generally limits venipuncture (36415, Collection of venous blood by venipuncture) to one unit per patient encounter, even if you draw multiple specimens. A patient encounter means the time from initial treatment/care until discharge from that treatment/care.

The Medicare Claims Processing Manual, Chapter 16, has this to say about routine venipuncture:

“A specimen collection fee is allowed in circumstances such as drawing a blood sample
through venipuncture (i.e., inserting into a vein a needle with syringe or vacutainer to draw the specimen).This fee will not be paid to anyone who has not extracted the specimen. Only one collection fee is allowed for each type of specimen for each patient encounter, regardless of the number of specimens drawn. When a series of specimens is required to complete a single test (e.g., glucose tolerance test), the series is treated as a single encounter.”

You’ll also find that many Medicare Administrative Contractors (MACs) have coverage guidance about venipuncture. For instance, CGS Administrators with jurisdiction in Kentucky provide the following information:

“Submit CPT code 36415 for all routine venipunctures, not requiring the skill of a physician, for specimen collection. This includes all venipunctures performed on superficial peripheral veins of the upper and lower extremities

Multiple venipunctures … during the same encounter, to draw blood specimen(s), may only be billed as a single procedure with units of service = 1 (one) regardless of the number of attempts or veins entered. In an ER setting, an “encounter” is considered admission until discharge. The venipuncture may be billed by the hospital as an outpatient charge. Physicians may not generally bill for routine venipuncture in a hospital site of service.”

36600: Regarding 36600(Arterial puncture, withdrawal of blood for diagnosis), the code is a physician service paid on the Medicare physician fee schedule. The physician may withdraw arterial blood to evaluate blood gases for certain patient conditions.

The service may be bundled, in certain situations, such as critical care. That’s why Correct Coding Initiative (CCI) lists 36600 as a column 2 code with critical care codes such as 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes).

Unlike 36415, there’s no national guidance about reporting multiple units of 36600, including no medically unlikely edit (MUE) restriction for the code. However, you should check local payer guidance about reporting multiple physician arterial punctures on the same date.

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