Cardiology Coding Alert

Question: Our physician performed an endovenous ablation procedure three days after seeing the patient and making the decision for surgery. On the day of the procedure, the physician submitted an H&P (history and physical), marking a code for an established visit. Can I separately bill this H&P on the same day as 36478?

Ohio Subscriber

Answer: You should not report the related H&P on the same day as the ablation (36478, Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated).

The procedure requires a brief related history, exam, and medical decision making (MDM), so it’s included with payment for the procedure.

Additionally, 36478 has a 000 global period. According to the Medicare physician fee schedule, 000 means: “Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.”

For additional information on global period E/M services, including proper use of modifiers, see Medicare Claims Processing Manual, Chapter 12, Section 40.2.A.8: www.cms.gov/manuals/downloads/clm104c12.pdf.