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Multiple units IR procedures - Medicare denials Neurosurgery

  1. #1
    Default Multiple units IR procedures - Medicare denials Neurosurgery
    Medical Coding Books
    Hi, our Medicare carrier is Palmetto (changed this year from Trailblazer) and we are having issues with getting payment on multiple units for IR procedures.

    For example, you can have 2 units of 36216 for the left side (one unit for the Int. Carotid and one for the vertebral as they are in seperate vessel/artery families). Med will pay for 1 unit and deny the 2nd. Then on appeal for the 2nd unit deny it as a duplicate.

    Anyone else having this issue? Anyone find a resolution to this issue?

    As this brings us to our major issue with this in when a spinal angiogram is done. We recently have done one and have 16 units of 36215 to bill (8 on the rt and 8 on the lt). This is just one of the many codes we have for this one procedure we need to bill with multple units with amounts over 4.

    Is there anyone else who are doing the spinal angiograms and do you mind sharing if you have had this issue with Medicare and if you have found a resolution to the problem? Any suggestions on how to best bill this out since we know 36215 -rt/lt 16 units is not an option. We are considering trying this break down:

    36215 -RT 1 unit
    36215 -59/RT 7 units
    36215 -59/LT 8 units

    Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    The medicare manula states that billing with units greater than 1 is not allowed except for procedures that come as quantity distributed, such as timed procedures and drugs. why not
    36215 50
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    assuming the procedure can be billed multiple times

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by mitchellde View Post
    The medicare manula states that billing with units greater than 1 is not allowed except for procedures that come as quantity distributed, such as timed procedures and drugs. why not
    36215 50
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    36215 59 50 ;
    assuming the procedure can be billed multiple times
    This answer is incorrect I apologize, I assume the poster is always applying the correct codes and may just need a modifier adjustment. This cannot be the case here. I do not always have access to my books but once I did in this case I looked at the codes, I am concerned that you are not applying the codes correctly, is it possible to append a copy of the note for this case? It would help to be more correct in a response. Again I apologize for a horribly incorrect response.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by sdougherty View Post
    Hi, our Medicare carrier is Palmetto (changed this year from Trailblazer) and we are having issues with getting payment on multiple units for IR procedures.

    For example, you can have 2 units of 36216 for the left side (one unit for the Int. Carotid and one for the vertebral as they are in seperate vessel/artery families). Med will pay for 1 unit and deny the 2nd. Then on appeal for the 2nd unit deny it as a duplicate.

    Anyone else having this issue? Anyone find a resolution to this issue?

    As this brings us to our major issue with this in when a spinal angiogram is done. We recently have done one and have 16 units of 36215 to bill (8 on the rt and 8 on the lt). This is just one of the many codes we have for this one procedure we need to bill with multple units with amounts over 4.

    Is there anyone else who are doing the spinal angiograms and do you mind sharing if you have had this issue with Medicare and if you have found a resolution to the problem? Any suggestions on how to best bill this out since we know 36215 -rt/lt 16 units is not an option. We are considering trying this break down:

    36215 -RT 1 unit
    36215 -59/RT 7 units
    36215 -59/LT 8 units

    Thanks!
    I think you might get a more accurate response by posting this in the Interventional Radiology forum. More of the experts in this field will look at posts that are in that forum.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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