Internal Medicine Coding Alert

Question: Do codes 99144, 36140, 36245, and 75710 require any modifiers to be paid when reported together?

Codify Member

Answer: You will find that Correct Coding Initiative (CCI) edits bundle 36140 (Introduction of needle or intracatheter; extremity artery) into 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family). If the situation supports reporting both codes (for example, there are two access points), you will need to append modifier 59 (Distinct procedural service) to 36140 to override the edit.

Before you override the edit, double check that you have two truly separate services.

Example 1: The cardiologist performs both a nonselective catheterization and a selective catheterization. He performs them through two separate catheters introduced into two separate arteries. In this case, you may append modifier 59 to 36140.

Example 2: The cardiologist performs the nonselective catheterization and selective catheterization at two separate patient encounters on the same date of service. In that case, you may report the appropriate selective catheter placement code (such as 36245) and 36140-59.

Caution: If the cardiologist performs nonselective catheterization simply because it's along the path of the selective catheterization he's performing, you should not report the nonselective catheterization separately. You should consider the nonselective procedure to be part of the more extensive selective procedure.

Other codes: You should not face bundling issues for the other codes you mention, 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) and 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time).