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Thread: 36000 with 99195?

  1. #1
    Join Date
    Apr 2007
    Greenville, NC

    Default 36000 with 99195?

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    Patient with hemochromatosis requires blood to be drawn off for ~30 minutes, 1 time a week for several weeks and then periodically once on mainetenance.

    99195 is what I am charging for therapeutic phlebotomy. Doc wants to also charge 36000 for the venous access to do the therapeutic phlebotomy. Is the 36000 included in the 99195 or should I bill both and use a modifier? If so, which modifier (51, 59, ?).

    Thanks for any help,

    Hunter Smith, CPC

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The access is inclusive to the procedure.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Greenville, NC

    Default Thanks


    Thanks, exactly what I told them, just wanted another CPC to agree with me to confirm I was on the right track.


  4. #4
    Join Date
    Apr 2007


    Could you please advise what documentation is needed and is there a minimal amount of blood to be withdrawn

  5. #5


    It is correct that 99195 includes 36000. However, 99195 is considered to be a separate procedure. Here's an interesting extract from the Medicine Guidelines: Separate Procedures: Second paragraph: "However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure , but is a distinct independent procedure. This may represent a different session or patient encounter, etc. etc."
    I think this means that you should report 99195-59 and not just 99195 by itself.

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