Wiki 36000 with 99195?

[hsmith67]

Patient with hemochromatosis requires blood to be drawn off for ~30 minutes, 1 time a week for several weeks and then periodically once on mainetenance.

99195 is what I am charging for therapeutic phlebotomy. Doc wants to also charge 36000 for the venous access to do the therapeutic phlebotomy. Is the 36000 included in the 99195 or should I bill both and use a modifier? If so, which modifier (51, 59, ?).

Thanks for any help,

Hunter Smith, CPC

 

[mitchellde]

The access is inclusive to the procedure.

 

[hsmith67]

Thanks

Debra,

Thanks, exactly what I told them, just wanted another CPC to agree with me to confirm I was on the right track.

Hunter

 

[wilccm]

Could you please advise what documentation is needed and is there a minimal amount of blood to be withdrawn

 

[pathfinder57]

It is correct that 99195 includes 36000. However, 99195 is considered to be a separate procedure. Here's an interesting extract from the Medicine Guidelines: Separate Procedures: Second paragraph: "However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure , but is a distinct independent procedure. This may represent a different session or patient encounter, etc. etc."
I think this means that you should report 99195-59 and not just 99195 by itself.