Cardiology Coding Alert

Question: Is 36620 bundled with 99291? One of our carriers denied our appeal and advised us that it is bundled.

Arizona Subscriber

Answer: Because it is a separate procedure, 36620 (arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) should not be reported separately if performed with any other surgical or invasive radiological procedure, according to Medicodes Coding Illustrated: Cardiovascular and Respiratory. But CPT guidelines do not specifically state that 36620 is among the codes included in critical care evaluation and management. Nor is 36620 bundled with critical care codes 99291-99292 in the national Correct Coding Initiative. Presumably this means that 36620 should be separately payable if billed with 99291. Your carrier may have its own guideline or may be confusing 36620 with 36600 (arterial puncture, withdrawal of blood for diagnosis), which is bundled with 99291 in the CCI. For example, First Choice, the Medicare carrier in Florida, also bundles 36620 and 99291, according to Lisa Clifford, CPC, an independent cardiology coding and reimbursement specialist in Naples, Fla.

Other carriers may want to see modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day as the procedure or other service) appended to 99291. You should check with your carrier to find out why the claim was denied and whether the carrier follows CPT and CCI guidelines or has its own policy for these situations.