Radiology Coding Alert

Similar revisions are now in place for 36200.

If you want proof that annual code updates go beyond definition revisions, check out these moderate sedation and global surgical package changes to 36200 and 36245-+36248.

1. Revision Sign Indicates Moderate Sedation Change

You'll find the following codes on the list of revised codes for 2012:

• 36200, Introduction of catheter, aorta
• 36245, Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
• 36246, ... initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
• 36247, ... initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
• +36248, ... additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate).

A quick comparison of the 2011 and 2012 definitions of these codes will show you that the wording remains the same. The revision is in the addition of the moderate sedation symbol to these codes, explained Sean P. Roddy, MD, of the CPT® Advisory Committee and Society for Vascular Surgery, in his CPT® and RBRVS 2012 Annual Symposium presentation.

The symbol means payers include moderate (or conscious) sedation as part of the fee for the procedure code. So the physician performing the catheter introduction or placement should not separately report 99143-+99145 (Moderate sedation services ...) for 36200 or 36245-+36248 services performed on or after Jan. 1, 2012.

2. Review the MPFS for Changes, Too

Before you submit a claim for these catheter introduction and placement codes in 2012, be sure you take into account changes to the global periods of 36200, 36246, and 36247.

In 2011, the global period for each of these codes was XXX. In 2012, 36200, 36246, and 36247 have a global period of 000.

Impact: The global period change means you should no longer separately report related E/M services performed on the same date as 36200, 36246, or 36247.

Here's why: In 2011, the codes had the classification XXX. That classification means the service is free of global surgical bundling issues, and you can separately report services that your physician performs on the same date as the surgical procedure, such as E/M services.

The XXX value means "that the global concept doesn't apply to the procedure," says Alice Kater, CPC, PCS, a South Bend, Ind., coder.

In 2012, the codes have a 000 indicator, which applies to the date of the procedure only. Medicare will bundle all related services that the physician performs on that surgery date into codes with the 000 indicator.

"000 is for endoscopic procedures or minor procedures" explains Chandra L. Hines, business office manager at a Raleigh, N.C., practice. "If you have a code with a zero-day global period, include related pre-operative and post-operative care on the day of the procedure only."

No mod 57: The 000 designation means you should not append modifier 57 (Decision for surgery) to an E/M service that resulted in the decision for surgery. Medicare Claims Processing Manual, chapter 12, section 40.2.A.4, states that "The '-57' modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure." (The manual is online at www.cms.gov/manuals/downloads/clm104c12.pdf.)

The other codes: Code 36245 continues to be classified as XXX in 2012. Code +36248 remains designated as ZZZ, which indicates it's an add-on procedure and is always included in the global period of the primary service you report it with. You may report +36248 in addition to 36246 (000 global) or 36247 (000 global).