In version 8.3 (effective 10/1/02), the Correct Coding Initiative (CCI)
provides the following edits (bundling of code pairs) for 36002, 76936 and
76942. I should note at the outset that Medicare contractors (carriers and
fiscal intermediaries) have not had the right to institute local bundling
edits since the inception of CCI (the single advantage providers/suppliers
have under CCI).
Compreh. = Comprehensive Code (i.e., the code that is allowed); Mod. = the
CCI modifier (0 = edit can not by bypassed under any circumstance; 1 = use
of some CPT modifiers will bypass the CCI edit); Compon. = Component Code
(the code that will be rejected - as in not paid)
Compreh. Mod. Eff. Date Term.Date Compon. Description
of Edit
36002 1 10/1/2002 36000 Standards of medical /
surgical practice
36002 1 10/1/2002 36410 Standards of medical /
surgical practice
36002 1 10/1/2002 37202 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 62318 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 62319 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 64415 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 64417 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 64450 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 64470 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 64475 Misuse of Column 2 code with
Column 1 code
36002 0 7/1/2002 69990 Misuse of Column 2 code with
Column 1 code
36002 1 10/1/2002 90780 Standards of medical /
surgical practice
36002 is a component code for a number of other procedures, none of which
are at issue here (e.g., other surgery codes).
76936 1 4/1/2002 76003 Misuse of Column 2 code with
Column 1 code
76936 1 4/1/2002 76360 Misuse of Column 2 code with
Column 1 code
76936 1 1/1/2002 76375 Misuse of Column 2 code with
Column 1 code
76936 1 4/1/2002 76393 Misuse of Column 2 code with
Column 1 code
76936 1 4/1/2002 76942 Most extensive procedures
76936 1 7/1/2002 76986 Misuse of Column 2 code with
Column 1 code
76936 1 1/1/1997 93922 "With" versus "without"
procedures
76936 1 1/1/1997 93923 "With" versus "without"
procedures
76936 1 1/1/1997 93924 "With" versus "without"
procedures
76936 1 4/1/1997 93926 "With" versus "without"
procedures
76936 1 1/1/1997 93930 "With" versus "without"
procedures
76936 1 1/1/1997 93931 "With" versus "without"
procedures
76936 1 1/1/1997 93990 "With" versus "without"
procedures
77418 1 1/1/2002 76936 Standards of
Medical/Surgical Practice
76942 1 7/1/2002 01922 Misuse of Column 2 code with
Column 1 code
76942 9 1/1/2002 1/1/2002 75989 Mutually exclusive
76942 1 7/1/1999 76095 Mutually exclusive
76942 1 1/1/2002 76360 Misuse of Column 2 code with
Column 1 code
76942 1 1/1/2002 76393 Misuse of Column 2 code with
Column 1 code
76942 is a component code of a large number of other procedures, none of
which are at issue here.
So, (1) this is not a CCI bundling edit and (2) no one else has the
authority to institute bundling edits. Consequently, I left wondering where
this originated. I suspect one of two sources. First, your fiscal
intermediary may had exceeded its authority, but I find this unlikely given
I have not found a single alpha code as an MSN or EOMB indicator. However,
if this is the case, I strongly suggest that you (1) initiate an appeals
process, (2) consider enlisting Bill Sarraille's assistance, & (3) contact
your regional CMS office given the FI would be in violation of CMS
instructions.
More likely, this may be an internal problem with your hospitals coding
system - in which case you might request specifics of the MSN/EOMB as well
as the CCI edit (which doesn't exist) - admittedly, you're sending your
nurse on a bit of a chase here but s/he needs to find out that this is not a
CCI issue & you should be paid for it. You may find that some 'expert' has
placed this edit in your system. It wouldn't be the first time that
happened ... just because someone is paid a lot of money does not make their
product useful (Enron?) ...
I have no significant expertise at billing supplies or medications in a
hospital setting. However, 36002, when valued at the PEAC & RUC (and
presumably subsequently by CMS), did not include thrombin in the equipment /
supplies list - lidocaine, needles, etc. is included. I suspect that this
was because thrombin is only one of several drugs that might, at some point
in the future, be used for this purpose and the CPT Editorial Panel, by
leaving the code more generic, saves themselves significant work down the
road (in their view, what is injected is not material to the procedure - an
injection is an injection). Still, given I do not find thrombin on the list
of drugs in HCPCS, I am uncertain as to how it would be charged. However,
it is not bundled under CCI and I suspect there is some mechanism to capture
the cost. You might want to check with those more knowledgeable than myself
about this.
********************
Franklin W. West
PVI
425.398.7774 (voice)
425.486.8976 (fax)
[log in to unmask]
********************
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of Michael, Dwight
Sent: Tuesday, November 12, 2002 3:48 PM
To: [log in to unmask]
Subject: Re: Ultrasound Guided Pseudoaneurysm Repair
Auditor says "N" means that these are included in a bundled charge adn
therefore are not allowed separate. Says that you must bill 36002 and that
the guidance charges are included as a bundled charge. According to her,
the Thrombin is also included in 36002. She audits hospital OP (APCs) if
that makes any difference. She never mentioned the EOMB and I didn't think
to ask. Thanks for the help!
-----Original Message-----
From: Franklin W. West [mailto:[log in to unmask]]
Sent: Tuesday, November 12, 2002 4:49 PM
To: [log in to unmask]
Subject: Re: Ultrasound Guided Pseudoaneurysm Repair
Someone has his or her wires crossed. CMS is not about to suggest that
ultrasound guidance is never covered for, e.g., pericardiocentesis,
endomyocardial biopsy, intrauterine fetal transfusion or cordocentesis,
chorionic villus sampling, amniocentesis, aspiration of ova, biopsy, needle
placement, etc. - even the bureaucrats at CMS understand this one. I
promise that the source of this problem is not CMS ... so find out where the
"N" came from & look at whatever 'official' descriptor of the abbreviations
exist (none of our EOMBs ever have a single letter descriptor - rather they
are a combination of alphanumeric values (e.g., MA25, CO42, etc.) with a
text descriptor ... e.g., "CO50" = "These are non-covered services because
this is not deemed a "medical necessity" by the payer." (Interpretation =
"in our esteemed medical opinion, we don't think the patient needed what you
did - no matter how it altered the clinical course of the patient ... & if
you disagree, then you can go through the appeals process" - with apologies
for the cynicism but I am, at the moment, tired of having to fight to get
paid for procedures that determined precisely what type of intervention was
performed). Time for some R&R ...
Eighty-odd wonderful folks that attended the SVU Current Issues meeting last
week (the 'odd' modifying eighty, not folks) have all the CMS statutes,
rules, regulations, manuals, transmittals and memoranda ... & one of you
gets to weigh in here ... Dwight is deserving of some help ...
<SNIP>
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