ED Coding and Reimbursement Alert

Question: I billed 36430-59 with place of service 23 (Emergency room - hospital). Medicare denied payment for the claim because of the place of service, so I changed it to 22 (Outpatient hospital). Again they rejected the claim, so I contacted them and asked, "What if the doctor performed the procedure?" The representative instructed me to submit a report, and when I did, they denied the claim a third time due to "inappropriate place of service." Is there a way to bill this and get reimbursed?
     
Idaho Subscriber

Answer: Unfortunately, CMS doesn't pay the physician for transfusions in the ED setting, so they won't reimburse you for 36430 (Transfusion, blood or blood components). They feel that it is a nursing service, so even if the physician does start the intravenous medication, the IV code does not have a physician work value and Medicare expects the facility to bill for the service.
 
While you may have luck with certain commercial payers (check with individual carriers), Medicare and other government programs will not reimburse for the professional component of this service.