Anesthesia Coding Alert

Question: We have been using code 36410* (venipuncture, child over age 3 years or adult, necessitating physicians skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture) for IV starts that are required outside the operating room; the unit charge is one unit. Medicaid/Medicare and some of our other insurers do not recognize this code. It has been suggested that we use code 36425 instead, which is a three-unit procedure and is recognized by Medicare. Is this code appropriate for IV starts, or does it have to include a cutdown?

New York Subscriber

Answer: Code 36425 (venipuncture, cutdown; age 1 or over) must include a cutdown before you can bill it as the procedure performed; otherwise, you are committing fraud if you code for a cutdown when a percutaneous is done. This is a more extensive procedure than an IV start, which is why it is a higher-unit procedure. Unless this is what was actually performed and the patients chart documents that a cutdown was specified, using code 36425 would be considered upcoding.

Your reimbursement problem may be because the carrier considers the IV start as bundled with the original procedure if it is done on the same day as surgery. IV starts usually are included in the anesthesia fee and should not be billed separately. But if the IV start took place at a separate time and it is appropriate to bill it separately, document the situation thoroughly and code it with modifier -59 (distinct procedural service) to show it was a separate procedure. In addition, most IVs are started by hospital staff members. If there is an exceptional instance where the patient has poor vein access and you are asked to start it, code the diagnosis as 459.89 (other specified disorders of circulatory system), document the situation, and be prepared to appeal.