Wiki Billing CPT 36000

[kristi.matthews@selfmedicalgroup.org]

According to the NCCI edits you can bill a 95857 with 36000 as long as a modifier 59 is on the 36000. When our office billed 95857, 36000-59 and
J0461 we were paid for the 95857 and the J0461 but according to the PCC at Medicare and the telephone appeals line the 36000 is a status B code and is never payble. It doesn't matter what you bill 36000 with it will never be paid. However, they can't tell me on their website where that info is posted. Does anyone have any advise on this? Thanks!

 

[OCD_coder]

The NCCI edits indicate that a modifier is allowed when it meets the criteria. I would recommend studying the code description then studying the criteria on how to appropriately apply modifier 59 for separately reportable procedures.

In order to perform the 95867 you MUST inject the inhibitor via IV, so the 36000 is inclusive of the procedure and not billable separately. They won't post something on the website we should understand how to use correctly. Medicare has created an edit with this code pair because you have to inject the inhibitor via an IV. You don't get paid for placing the IV catheter also.


CPT Lay Description - 95867
This test for myasthenia gravis involves injecting a cholinesterase inhibitor (edrophonium chloride) intravascularly. After administration by a physician, eye muscle abnormalities markedly decrease within two minutes in individuals with myasthenia gravis.

 

[memoor67]

What if?

my provider is billing on one claim 99214-25, then on a second claim bills 36000-59, 96365, 99211-25, A4223, J1335, J7050. What does the documentation need to say to support billing with modifer 59 on 36000? Also I do not understand why provider is billing two EM visits either. Can someone explain that to me? thanks.