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Billing Question - Bundling of 36902 with 36581

Posted By Reuben K. Ellis, Tuesday, April 10, 2018

I was just notified by my billing company that one of our major private carriers (UHC) is bundling the 36902 code with 36581 for all their patients. Thus they are denying the 36902. Has anyone else run into this problem and how did you resolve it. I have scheduled a physician to physician conference call with the medical director to express my disagreement with there ruling. I would love to hear anyone else’s similar experience.

 

Best Regards R Kris Ellis MD FASN, FASDIN

Tags:  Coding 

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Comments on this post...

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Joseph J. Oolut says...
Posted Tuesday, April 10, 2018
36902 is fistula/PTA, you code that along with 36581? I don't ever code those two together?
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Reuben K. Ellis says...
Posted Tuesday, April 10, 2018
When doing a fibrin sheath angioplasty on a catheter exchange I code 36902 along with 36581. How do others code for this?
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Randy I. Cooper says...
Posted Tuesday, April 10, 2018
36902 is specific to fistulagram with angioplasty of the peripheral AV access.

When doing a fibrin sheath disruption, the most appropriate code would be 36595 unless you could demonstrate that there was not only a fibrin sheath but also a central venous stenosis, in which case the appropriate code would be 37248 (central venous angioplasty from a non-dialysis access circuit).

Of note -- if you were doing a fistulagram and only found a flow limiting central venous stenosis that required intervention, the 36902 code would not be appropriate as that code is specific for an angiogram with angioplasty of the peripheral segment of the dialysis access. In this case -- you would code 36901 (angiogram of the dialysis access circuit) and the add-on code, 36907 (angioplasty of the central segment of the dialysis circuit/central veins since the approach is from the dialysis circuit).

Although this is the correct coding, please keep in mind, the new add-on codes (36907-36909) are only fully reimbursable in the extension of practice setting and not reimbursable in the ASC setting (other than the professional component)

Hope that helps
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Joseph J. Oolut says...
Posted Tuesday, April 10, 2018
Correct, that's basically how I code it. In fact for cath exchange if you are coding 36902 I don't think you would be getting reimbursed for that?

I do not routinely code 36595 on an exchange but will do 37248 with a distinct stenosis.
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Reuben K. Ellis says...
Posted Tuesday, April 10, 2018
Most helpful. Thanks! I will make the corrections in billing
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Mary L. Nations says...
Posted Tuesday, April 10, 2018
Check out catheter case 8; page 110 of the 2018 ASDIN/RPA Coding Manual
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