Billing 36591


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Does anyone have the article from CPT assist talking about charging CPT 36591 with other services. I understand the CPT assist addressed this issue. Any help is appreciated.
Is this what you are referring to?

E/M services updates for 2007 - pediatric critical care transport
CPT Assistant, July 2007 Pages: 2,3 Category:
Related Information

Pediatric Critical Care Patient Transport

The guidelines for codes 99289 and 99290 that are used to report the physical attendance and direct face-to-face care by a physician during the interfacility transport of a critically ill or critically injured pediatric patient were revised.

The list of services and procedures included when pediatric critical care patient transport is reported and that may not be reported separately include the following:

Ÿ Routine monitoring evaluations (eg, heart rate, respiratory rate, blood pressure, and pulse oximetry)

Ÿ The interpretation of cardiac output measurements (93561 and 93562)

Ÿ The interpretation of chest X rays (71010, 71015, 71020)

Ÿ The interpretation of pulse oximetry (94760-94762)

Ÿ The interpretation of blood gases and information data stored in computers (eg, ECGs, blood pressures, hematologic data) (99090)

Ÿ Gastric intubation (43752, 91105)

Ÿ Temporary transcutaneous pacing (92953)

Ÿ Ventilator management (94002-94004, 94660, 94662)

Note from 3M:
As of January 1, 2008, 36540 has been deleted. To report, use 36591

Ÿ Vascular access procedures (36000, 36400, 36405, 36406, 364101, 36415, 36540, 36600)

Any services performed that are not included in this list should be reported separately.

From this list of inclusive procedures and services, codes 94656 and 94657, previously reported for ventilation assist and management, have been deleted. In their place, the new Ventilator Management series 94002-94004 has been added with expanded code descriptors for ventilator management in various settings. Following is the new subcategory of ventilation management codes and the code descriptions that have been added to the Patient Transport guidelines.

94002 Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day

94003 hospital inpatient/observation, each subsequent day

94004 nursing facility, per day

Coding Tip

Do not report 94002-94004 in conjunction with E/M services 99201-99499.

94005 Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes or more

Coding Tip

Do not report 94005 in conjunction with services 99339-99340 and 99374-99378.

CPT Assistant © Copyright 1990–2008 American Medical Association. All Rights Reserved
here is the most recent one, not sure if this is what your looking for but here it is:

Year: 2008

Issue: April

Pages: -9

Title: Coding Communication: Collection of Blood

Body: The American Cancer Society reports that there were approximately 1.4 million new cases of cancer diagnosed in 2006. For as long as patients have had peripherally inserted central venous catheters (PICC) or peripheral intravenous (IV) lines, physicians and nurses have been able to obtain blood for clinical laboratory by these routes. 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. These services are commonly performed in the office or other outpatient setting, hospital inpatient setting, and hospital outpatient setting. Medical oncologists, hematologists, and other health care providers commonly report this service.

Prior to 2008, codes 36415, 36416, and 36540 represented blood collection methods.

These codes were inadequate to report the services of collecting blood from a PICC or peripheral IV line.

In 2008, codes 36540 and 36550 were renumbered to 36591 and 36593, respectively, and moved from the Venous section to the Central Venous Access Procedures/ Other Central Venous Access Procedures section. No changes were made to the code descriptors.

36591 Collection of blood specimen from a completely implantable venous access device

36593 Declotting by thrombolytic agent of implanted vascular access device or catheter

A new code was added toCPT 2008in the Surgery/ Cardiovascular section under the new subsection
“Other Central Venous Access Procedures” to report blood draws via routes including PICC lines and other peripheral IV lines:

36592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified

Prior to the establishment of CPT code 36592, physicians who were drawing blood via PICC lines and other peripheral IV lines were reporting this commonly performed service with an “unlisted procedure” code or not reporting it at all.

Clinical Example (36592)

A 54-year-old male with a PICC line for eight weeks of antibiotic therapy requires a blood sample for hematology and chemistry testing.

Description of Procedure (36592)

The registered nurse reviews the patient chart for orders and obtains a medical history (eg, chemo-
therapy-related history). The patient is greeted, gowned, and positioned for a blood draw. The
blood draw is completed by the nurse (1) drawing
a 10-cc syringe full to discard, (2) drawing a second syringe to collect the blood specimen, and (3) flushing the line. The nurse labels the blood specimen and places it in the appropriate container for transport to the clinical laboratory.¿