Susan m Posted 5 Year(s) ago
We have been using CPT 36561 to code Mediport catheters inserted for chemotherapy administration, and we code the cancer (162.9, 174.9, etc.) as the diagnosis. Novitas, our Medicare carrier, excludes the cancer diagnoses as codes that support medical necessity for that CPT code. In fact, CPT 36561 is addressed only in Novitas LCD for vascular acces for hemodialysis. We know these catheters are used for other purposes as well as dialysis. Are we coding this procedure correctly? Is there another way we can code this to satisfy Novitas?
SuperCoder Posted 5 Year(s) ago
It appears that the intent of Novitas is not to say only the ICD-9 codes in the policy support 36561, but that when 36561 is used in relation to dialysis, those ICD-9 codes are the ones that support medical necessity.
Just above the ICD-9 codes, Novitas’s policy says when 36561 is used “to report the services described in this LCD (appropriate evaluation of the patency of an established hemodialysis fistula and the percutaneous interventions needed to enhance or re-establish patency of that hemodialysis fistula), the following diagnosis codes will be considered by Medicare to support medical necessity.”
Earlier it says, “Coverage of CPT 36561 (insertion of tunneled CENTRAL VENOUS ACCESS device, with subcutaneous port) as it relates to this LCD is specific only to vascular access for hemodialysis.”
If Novitas will not respond to that reasoning, you may find help with your local oncology society.
Some coders report the use of V58.81 (along with a malignancy code) for the fitting. But this code is also not included in the Novitas policy.
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