CPT® 36415 Multiple Surgery Rules

Does anyone know if CMS changed the multiple surgery rules for CPT® 36415 billed with anothe surgery on the same day. For example we billed 36415 along with 17000 & 17003. The insurance (DG) is reducing 36415 by 50% according to "multiple surgery" rules. They are stating, per CMS. Where can I find the rule that states 36415 is excluded from this rule? Thanks

re: CPT® 36415 Multiple Surgery Rules

Ridiculous. This CPT® is not considered a surgery code and is not subject to reduction. Though, some payers are deciding not to pay it at all.

re: CPT® 36415 Multiple Surgery Rules

We do know that some insurances do consider it bundled. However, this particular insurance is a Medicare Cost-Share plan. I am thinking they did a recent update to their editing system and this was included in their surgery section. I will be contacting this particular insurance to find out where they got their info from.

re: CPT® 36415 Multiple Surgery Rules

[Does anyone know if CMS changed the multiple surgery rules for CPT® 36415 billed with anothe surgery on the same day. For example we billed 36415 along with 17000 & 17003. The insurance (DG) is reducing 36415 by 50% according to "multiple surgery" rules. They are stating, per CMS. Where can I find the rule that states 36415 is excluded from this rule? Thanks]

Are you performing 36415 DURING the surgery?

Go to cms.gov and go to your carrier's website to see if there are any LCDs or NCCIs that you are not aware of. I didn't think that you could bill for venipunture during a surgical procedure but I do professional fee coding so the rules may be different for facility.

re: CPT® 36415 Multiple Surgery Rules

That does look odd. Usually, with 36415 one would see lab codes as well. If, those are the only 3 codes being billed I would say 36415 is a coding error.

re: CPT® 36415 Multiple Surgery Rules

There were lab charges also (I just didn't mention them when I asked the question). The surgeries that were performed (we have about 7 patients this happened to) were for procedures like: ear lavage, debridements, wart destructions. No major surgeries. These were minor procedures done in the office in conjuction with other services. I contacted DG and they are going to look into it on their end to see if this is possibly a "code edit" error on their end.