Primary Care Coding Alert

Question: When I filed 36000 with 99214-25 and 99195, Medicare denied 36000 as inclusive/bundled into the global. Should I appeal the carrier's decision or use a different modifier?

Virginia Subscriber

Answer: No, you shouldn't appeal for 36000 (Introduction of needle or intracatheter, vein) payment. The National Correct Coding Initiative edits bundle 36000 into most surgical/anesthesia services. Because the physician can't perform the given procedure without inserting a needle, NCCI considers 36000 mutually exclusive to the more extensive procedure.
 
For instance, in your scenario, the family physician can't perform phlebotomy (99195, Phlebotomy, therapeutic [separate procedure]) or draw blood from a vein without inserting a needle. Therefore, 99195 includes 36000.
 You should, however, report 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...) in addition to 99195 if the FP performs and documents a significantly identifiable E/M service from the phlebotomy. The E/M service would probably have to be unrelated to the phlebotomy encounter. And, you should append modifier  -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit code.

 - Answers to You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, HIM certificate programs coordinator at Clarkson College in Omaha, Neb.; Lynn M. Anderanin, CPC, senior coding consultant for Health Information Services in Des Plaines, Ill.; Marie Felger, CPC, a member of the American Academy of Family Physicians FPM Coding & Documentation review panel; Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; and Kent J. Moore, manager of Health Care Financing and Delivery Systems for the AAFP in Leawood, Kan.