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INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 11/25/2003 Title: Arterial Catheterization
Revision Date: 08/11/2005 Document: BI014:00
CPT Code(s): 36620
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above Revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Arterial Catheterization or cannulation is the process of establishing a line, similar to an IV, in an artery. It is billable when it is an isolated event, such as for sampling or transfusion. It is not billable when it is part of a global event, such as a surgical procedure.


Medical Statement

CPT 36620 is listed in the CPT book as a “separate procedure*,” indicating it should not be unbundled from a global service. Therefore, 36620 should not be unbundled.

 

*From the CPT Expert, 2004 edition, published by the AMA:

“Separate procedures are services that are commonly carried out as an integral part of a larger service, and as such does not warrant separate identification.  These services are noted in the CPT book with the parenthetical phrase (separate procedure).  When this phrase appears before the semicolon, all indented descriptions that follow are covered by it.

“Separate procedures are often improperly reported as related procedures.  Related procedures are performed for the same diagnosis and within the same operative area.  Reporting a separate procedure in addition to the larger procedure to which it is related is improper.  A separate procedure can be a component of, or incidental to, a larger, related procedure.”

 

After investigation, it is clear that 36620 are not held to be a portion of any anesthetic base code.  Therefore, it is billable as a separate procedure by anesthesiologists intending to use the arterial line for monitoring of blood pressure or arterial oxygenation during an anesthetic. Because anesthesiologists are generally paid in base and time units, this code will normally have to be billed separately, with the anesthesiologist’s medical provider number, to allow it to pay correctly.

 

Codes Used In This BI:

 

36620           Insertion Catheter Artery


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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