ED Coding and Reimbursement Alert

Question: My doctors often do ultrasound guided peripheral IV access. For these patients, our providers usually placed ultrasound guided peripheral IVs. There is a code CPT^® 36000 to bill for this; however, we were recently told that this is bundled into the E/M service. Is this true? Where can I find documentation of this?

Texas Subscriber

Answer: There isn't any documented policy or guideline that would prevent the emergency physician from reporting 36410 (Venipuncture, child age 3 years or older, necessitating the skill of a physician or other qualified health care professional [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]). But note that it would not be appropriate to report code 36000 if the physician performs the venipuncture merely because the nurse, phlebotomist, or other health professional is unavailable to perform the service rather than it being a situation where the venipuncture required the physician's skill over other available providers present.

There are no CCI edits that restrict the use of the code with an E/M service except for 99291, because the peripheral IV code is on the list of bundled vascular access procedures when performed in conjunction with critical care in the list of vascular access procedures (36000, 36410, 36415, 36591, and 36600).  However you should also check your local coverage decision (LCD) memos form you Medicare carrier to verify there are no regional restrictions.

However, the better code choice would be the ultrasound add on code +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentations of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure] ) when this service is performed by the provider, provided that all of the requirements for reporting the codes are met. That may have been the reason for your denial when using code 36000.