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Lori Posted Tue 08th of August, 2017 19:52:06 PM
We have a provider who gave us with the following cpt's for their claim. 37224 37220 75630 26 XU 36200 59 Medicare paid the entire claim. Our guidance to the provider has been "if" the service becomes interventional and not solely diagnostic, then 36200 would be bundled and not payable. What would be an appropriate example of using 36200 with a modifier 59 so the code is unbundled and paid correctly? When is it appropriate to unbundle this code?
SuperCoder Answered Wed 09th of August, 2017 05:55:17 AM

 

Vascular catheterizations should be coded to include introduction and all lesser order catheterizations used in the approach (eg, the description for a selective right middle cerebral artery catheterization includes the introduction and placement catheterization of the right common and internal carotid arteries). Aorta is the base artery, from where division of vascular family initiate. Additional second and/or third order arterial catheterizations within the same family of arteries supplied by a single first order artery should be expressed. Additional first order or higher catheterizations in vascular families supplied by a first order vessel different from a previously selected and coded family should be separately coded using the conventions described above.

In this case, bundling occurs when a procedure or service with a unique CPT code is included as part of a more extensive procedure or service provided at the same time. Some services allowed to bill together in order to differentiate between the services provided by appending modifier 59. Out of few of the examples, 36200 can be coded with modifier 59 when billed with code ranges 33361-33369, 33400-33406, etc. On the other hand, CPT 36200 can is unbundled with other mutually exclusive procedures, like 35206, 35226, 35231,35236, etc, these codes require the modifier 59 when billed with CPT 36200. However, unbundling can be any such service where CPT 36200 is extremely not related to the other service, for example: temporary pacemaker, endoscopy of great vessels, etc.

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