Wiki Cardiac Assist Procedures

[apcarter]

When billing for services 33960 initial 24 hour prolong extracorporeal circulation; if a different provider provide the service on 2nd day should this provide also use the initial 24 hour code (33960)?

How are the subsequent days billed if the same physician does not see the patient on the second day but does so on the third day?

 

[jdrueppel]

If the 2nd provider is same specialty, same group 33961 would be used for the subsequent 24 hours. Provider from different group would report 33960 for their first 24 hour series and 33961 for each subsequent 24 hours. If care was handed back to starting group, they would report any additional 24 hours under 33961 as they have already billed initial.

Julie, CPC

 

[apcarter]

Cardiac Assist Procedure

Thank you very much for the immediate response to my coding question, however, I was also concerned how regarding another matter.

We have insistance where patients are in the hospital for several months and have continued to receive these services on subsequent days. However, how would you code a situation when a provider is not part of the same group, and bills individually, rendered services on day and does not see the patient for another week or several weeks later.

Would this provider bill for an initial service or would the provide bill the added on code along with the primary code, which was performed several weeks prior. This is a long time to wait to bill this claim, due to the fact that the add on code must be billed with the primary code....

 

[jdrueppel]

I agree - it seems a billing nightmare if billing only subsequent 33961 and I'm not sure providers are willing to hold charges until the ECMO is decannulated. Depending on the size of the practice, I would be afaid that other, bundled charges might be billed out in error or without appropriate modifiers in error. The CPT guidelines state 33961 is an add-on code and cannot be billed without the primary/initial code of 33960. I've been searching the web for other interpretations but have not found anything but I'll keep looking and respond if I find something. In the meantime, I would suggest calling Medicare and inquiring about billing specifications in this circumstance. Also if you do a search of the AAPC forums and search posts and threads with "33960" and "ECMO" there have been some conversations about these codes that suggests 33961 has been paid when NOT submitted with the primary code of 33960.

Sorry I couldn't be of more help and, if you do call Medicare (or another big payer), I'd be interested in hearing what they say.

Julie, CPC