Wiki Rev Code for 36593

[tboersma]

Does anyone know what Rev Code I would use for 36593 (Declotting by Thrombolytic Agent of Implanted Vascular Device or Catheter)?
On the cms.gov website (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=55237) the article titled (Billing and Coding:Thombolytic Agents) it refers to 36593 and toward the end of the article, it lists 636 (Pharmacy - Drugs Requiring Detailed Coding). Is it the Thrombolytic Agent that is driving the Rev Code so 636 would be appropriate?
Someone suggested 361 (Operating Room Minor Surgery) but this didn't take place in the OR.
Would a 26X code be more appropriate?
Any insight would be helpful!

 

[thomas7331]

Revenue code assignment is driven more by payer requirements and hospital cost center reporting than it is by coding guidelines. You may need to check with your payer on this or else consult the NUBC manual. In my experience, this task was always handled by people in the hospital finance department who were responsible for the charge master, not by coders.

I think our facility billed these types of procedures with a 36X revenue code, 369 if I recall correctly. I don’t believe that it’s necessary for the procedure to actually be done in the hospital OR to use those revenue codes. If you’re uncomfortable with that though, I think your only alternative is in the 76X range for a procedure room, perhaps 762. 26X is not correct though as that’s for IV drug administrations, those routinely performed by nursing staff.

 

[sls314]

Does anyone know what Rev Code I would use for 36593 (Declotting by Thrombolytic Agent of Implanted Vascular Device or Catheter)?
On the cms.gov website (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleID=55237) the article titled (Billing and Coding:Thombolytic Agents) it refers to 36593 and toward the end of the article, it lists 636 (Pharmacy - Drugs Requiring Detailed Coding). Is it the Thrombolytic Agent that is driving the Rev Code so 636 would be appropriate?
Someone suggested 361 (Operating Room Minor Surgery) but this didn't take place in the OR.
Would a 26X code be more appropriate?
Any insight would be helpful!

Revenue Code 636 would definitely not be appropriate. That revenue code is for drugs/pharmaceuticals, not for procedures. (Same goes for 26x)

I agree with the rest of what Thomas stated.

 

[tboersma]

Revenue code assignment is driven more by payer requirements and hospital cost center reporting than it is by coding guidelines. You may need to check with your payer on this or else consult the NUBC manual. In my experience, this task was always handled by people in the hospital finance department who were responsible for the charge master, not by coders.

I think our facility billed these types of procedures with a 36X revenue code, 369 if I recall correctly. I don’t believe that it’s necessary for the procedure to actually be done in the hospital OR to use those revenue codes. If you’re uncomfortable with that though, I think your only alternative is in the 76X range for a procedure room, perhaps 762. 26X is not correct though as that’s for IV drug administrations, those routinely performed by nursing staff.

Thank you, I appreciate your response!
I agree, I've never worked the Rev Codes either but this provider wants the coders to make these determinations. I will try to find the payer requirements.
In this particular instance, the declotting took place in Infusion which is why I was leaning toward the IV Therapy codes (26x) and the nurse was the one handling the process, either 262 (pharmacy services) or 269 (other). Any thoughts on that?

 

[tboersma]

Revenue Code 636 would definitely not be appropriate. That revenue code is for drugs/pharmaceuticals, not for procedures. (Same goes for 26x)

I agree with the rest of what Thomas stated.

Thank you for responding!
I agree regarding 636 but when the CMS article made reference to that Rev Code, I thought perhaps in this case the drug was making the determination. But I understand what you are saying.

 

[thomas7331]

Thank you, I appreciate your response!
I agree, I've never worked the Rev Codes either but this provider wants the coders to make these determinations. I will try to find the payer requirements.
In this particular instance, the declotting took place in Infusion which is why I was leaning toward the IV Therapy codes (26x) and the nurse was the one handling the process, either 262 (pharmacy services) or 269 (other). Any thoughts on that?

Honestly, I don't think it's going to make much difference for most payers. Medicare, for one, prices outpatient hospital claims based on the CPT/HCPCS codes, not the revenue codes. They do have a limited set of codes for which they require specific revenue codes, but the majority of codes they allow the hospital to make the determination. However, if you aren't familiar with your provider's different payers' policies and contract stipulations, you're likely to end up having some denials too. CPT codes in the 10000-69999 surgical range are typically reported under the 36X revenue code, but I don't think there's a blanket rule that says it necessarily has to be this way.

Again, this all involves hospital cost center reporting in addition to just billing and coding, which is why finance is usually the one handling this - the revenue code assignments are made at the time that items are entered into the charge master and coders shouldn't need to be concerned about it after that. If you're going to be tasked with revenue code assignment, your provider really should be giving you some training for this responsibility. It isn't a matter of searching the internet or a coding resource for answers - it's more complicated than just finding the best code to use as it's very hospital-specific and payer-specific. Your provider should also give you a subscription to the NUBC manual as you will need that as one of your primary references. Some encoders also may have tools to guide you on this or may include the NUBC manual as an add-on. I think that without clear guidance from your provider, if you have to be finding revenue codes by doing searches for guidelines or by trying to guess at the best match just from code descriptions, you're going to drive yourself crazy.

 

[tboersma]

Honestly, I don't think it's going to make much difference for most payers. Medicare, for one, prices outpatient hospital claims based on the CPT/HCPCS codes, not the revenue codes. They do have a limited set of codes for which they require specific revenue codes, but the majority of codes they allow the hospital to make the determination. However, if you aren't familiar with your provider's different payers' policies and contract stipulations, you're likely to end up having some denials too. CPT codes in the 10000-69999 surgical range are typically reported under the 36X revenue code, but I don't think there's a blanket rule that says it necessarily has to be this way.

Again, this all involves hospital cost center reporting in addition to just billing and coding, which is why finance is usually the one handling this - the revenue code assignments are made at the time that items are entered into the charge master and coders shouldn't need to be concerned about it after that. If you're going to be tasked with revenue code assignment, your provider really should be giving you some training for this responsibility. It isn't a matter of searching the internet or a coding resource for answers - it's more complicated than just finding the best code to use as it's very hospital-specific and payer-specific. Your provider should also give you a subscription to the NUBC manual as you will need that as one of your primary references. Some encoders also may have tools to guide you on this or may include the NUBC manual as an add-on. I think that without clear guidance from your provider, if you have to be finding revenue codes by doing searches for guidelines or by trying to guess at the best match just from code descriptions, you're going to drive yourself crazy.

I completely agree with your comments and you are absolutely correct, I am going crazy. I really do appreciate your insight and have a better grasp of reasoning that I can take to the provider. Thank you!

 

[thomas7331]

I completely agree with your comments and you are absolutely correct, I am going crazy. I really do appreciate your insight and have a better grasp of reasoning that I can take to the provider. Thank you!

You're welcome. If nothing else, try to get hold of the NUBC manual as that will probably help solve some of the more basic issues. A single user subscription is $170 which is not prohibitively expensive, so I don't see why your provider couldn't cover that for you: https://www.nubc.org/subscription-information