36591 blood draw and chemo admin

[kabrodie]

In several older threads various people stated (paraphrasing here) that if you access a site for an infusion but draw a blood specimen from the same site/access before starting the infusion you cannot bill separately for both so bill the infusion. CPT guidelines under codes 36591 and 36592 state "don't report in conjunction with any other service" and infusion guidelines state IV start or access to indwelling site are included in the infusion. On the other hand, 36591 does not edit out against infusion codes.

CPT Assistant April 08 doesn't really answer the question about whether or not a blood draw from a port is reportable in conjunction with an infusion. In fact, in their rationale for establishing a new code they state "On every occasion that chemotherapy is administered and the oncologist or other physician is accessing the vein, it is more convenient and less invasive to draw blood from the same line if a specimen is necessary for testing". Makes it seem the two services are reportable together.

So...confused. Any thoughts?
thanks
KB

 

[hnroberts]

Is the port accessed two different times, once for the draw and once for the infusion? Or is it accessed once( the blood is collected and then the drugs are infused all under the same access path)? If it is just one access for all services, then you can only bill the infusion codes, but if it's two seperate accesses you can bill the infusion codes and the 36591(w/ 59 mod). Hope this helps!