Other Central Venous Access Procedures

April 24th, 2013 - Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT

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CPT codes 36591-36598

The Physician Fee Schedule assigns a “code status” to CPT/HCPCS codes each year. It is important to understand the “status” code and how it relates to Medicare coverage and payment.

MEDICARE STATUS CODES

A = Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.

B = Bundled Code. Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amount for these codes, and no separate payment is made. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient).

C = Carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report.

D = Deleted Codes. These codes are deleted effective with the beginning of the applicable year.

E = Excluded from Physician Fee Schedule by regulation. These codes are for items and/or services that CMS chose to exclude from the fee schedule payment by regulation. No RVUS or payment amounts are shown and no payment may be made under the fee schedule for these codes. Payment for them, when covered, generally continues under reasonable charge procedures.

F = Deleted/Discontinued Codes. (Code not subject to a 90 day grace period).

G = Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code subject to a 90 day grace period.)

H = Deleted Modifier. This code had an associated TC and/or 26 modifier in the previous year. For the current year, the TC or 26 component shown for the code has been deleted, and the deleted component is shown with a status code of "H".

I = Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.)

N = Noncovered Services. These services are not covered by Medicare.

P = Bundled/Excluded Codes. There are no RVUs and no payment amounts for these services. No separate payment should be made for them under the fee schedule.

--If the item or service is covered as incident to a physician service and is provided on the same day as a physician service, payment for it is bundled into the payment for the physician service to which it is incident. (An example is an elastic bandage furnished by a physician incident to physician service.)

--If the item or service is covered as other than incident to a physician service, it is excluded from the fee schedule (i.e., colostomy supplies) and should be paid under the other payment provision of the Act.

R = Restricted Coverage. Special coverage instructions apply. If covered, the service is carrier priced. (NOTE: The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D". We are assigning the indicator to a limited number of CPT codes which represent services that are covered only in unusual circumstances.)

T = Injections. There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. (NOTE: This is a change from the previous definition, which states that injection services are bundled into any other services billed on the same date.)

X = Statutory Exclusion. These codes represent an item or service that is not in the statutory definition of "physician services" for fee schedule payment purposes. No RVUS or payment amounts are shown for these codes, and no payment may be made under the physician fee schedule. (Examples are ambulance services and clinical diagnostic laboratory services.)

There are also “global day” indicators:

Global Period - The field provides the postoperative time frames that apply to payment for each surgical procedure or another indicator that describes the applicability of the global concept to the service.

000 - Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.

010 - Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10 day postoperative period included in the fee schedule amount; evaluation and management services on the day of the procedure and during this 10 day postoperative period generally not payable.

090 - Major surgery with a 1 day preoperative period and 90 day postoperative period included in the fee schedule payment amount.

MMM - Maternity codes; usual global period does not apply

XXX - Global concept does not apply

YYY - Carrier determines whether global concept applies and establishes postoperative period, if appropriate, at time of pricing

ZZZ - Code related to another service and is always included in the global period of the other service.

CPT codes 36595, 36596, 36597, and 36598 have” 0” global days.

CPT codes 36591, 36592, and 36593 have global day indicator of “xxx” (does not apply).

Status codes:

Medicare Claims

Codes 36591, 35592, 36598, have a “T” status (T = Injections. There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. (NOTE: This is a change from the previous definition, which states that injection services are bundled into any other services billed on the same date.)

CPT codes 36593-36597 have an “A” status (A = Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy).

The coder must know the “status” and the “global day” indicators before assigning a code. This pertains to all codes under the Physician Fee Schedule (updated each year).

CPT codes 36591, 36592

Payers will have individual policies for these codes (to include 36415, and 36416). Example: when a provider draws blood and performs one of the following laboratory services (85002-85999 or 87800-87906) the Venipuncture is considered an integral part of the lab service and will not be reimbursed separately.

BC/BS Policy: Policy Section 2: Services and supplies not eligible for separate reimbursement when billed with another specific procedure or service.

These bundled services may include, but are not limited to:

1. Collection of blood specimen from a completely implantable venous access device or an established venous central or peripheral catheter when performed with other than a laboratory service. 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).

Some payers will reimburse codes 36591 or 36592 when billed with another laboratory service (8xxxx).

Code 36593:

Code 36593, Declotting by thrombolytic agent of implanted vascular access device or catheter, can be reported multiple times in one day when performed more than once. The declots must be separate sessions and not just be sequential administration of tPA during the same episode of care. Code 36593 should not be used for routine flushing of a central venous access device with saline or heparin.

Medicare has an MUE frequency of “2” per day (36593).

Code 36593, example Dialysis:

Declotting by thrombolytic agent of implanted vascular access device or catheter (36593). This code reports declotting of completely implanted devices and catheters. This procedure necessitates the use of a thrombolytic agent (e.g., Urokinase) that is introduced through a syringe and then slowly instilled into the device or catheter. (Generally considered to be a single bolus of thrombolytic agent.) This code is not to be used for routine flushing of vascular access devices with saline or heparin. This type of flushing is considered inclusive to dialysis services and is not reported separately.

Medicare MUE Values:

36592  1

36593  2

36595  2

36596  2

36597  2

36598  2

The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE.

Code 36595, 36596

Code 36595- Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access; and code 36596, Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen.

Radiology practices should continue to use the radiological supervision and interpretation (RS&I) codes as cross-referenced in the parentheticals following codes 36595-36596, i.e., 75901 (Mechanical removal pericatheter obstructive material, RS&I) should be used with 36595, and 75902 (Mechanical removal intraluminal obstructive material, RS&I) should be used with 36596.

CPT code36597

Repositioning of previously placed central venous catheter under fluoroscopic guidance

Continue to report 76000 (Fluoroscopic guidance, up to 1 hr) for the fluoroscopic guidance used in repositioning a CVA catheter as directed in the cross-reference following code 36597. Do not report the newly established fluoroscopic guidance code associated with CVA.

Code 36598

This code has a “T” status. Contrast injection to evaluate existing central venous access device, includes fluoroscopy. There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. No modifier overrides will exempt T status codes from bundling into the services for which payment is made.

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