infusion for thrombolysis - StreamlineMD

REIMBURSEMENT CORRECTION SLATED - INFUSION FOR THROMBOLYSIS
July 2013
Good news ahead! If you are performing either bilateral arterial or bilateral venous infusion for thrombolysis, you
will now be able to get paid for both sides. Prior to the recent CMS - Change Request MM8291 , even if you
performed the procedure bilaterally, it would only be reimbursed as a unilateral.
What happened?
With an implementation date of July 1, 2013, effective for dates of service beginning January 1, 2013, CMS is
correcting the bilateral indicator from a “0” to a “1” for CPT codes 37211 and 37212. This information can be found
in the CMS, Medicare Physician Fee Schedule MPFS
Bilateral indicator
0 Bilateral payment does not apply
1 150% payment for bilateral procedures applies
Example:
CPT code descriptions
37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary,
any method, including radiological supervision and interpretation, initial
treatment day
37212 Transcatheter therapy, venous infusion for thrombolysis other than coronary,
any method, including radiological supervision and interpretation, initial
treatment day
Catheter is placed in the right lower lobe pulmonary artery and thrombolysis is performed for over an hour. A
second access is obtained, and an infusion catheter for thrombolysis is placed in the left upper lobe for
thrombolysis for two hours.
Coding: 37211-50 or 37211-LT and 37211-RT (depending on payer preference)
Prior to this update, assigning modifier 50 or modifiers LT and RT to indicate the procedure was
performed bilaterally could only be reimbursed as a unilateral procedure.
What do I need to know:
For dates of service on or after January 1, 2013, if you performed these procedures bilaterally, you are now eligible
for reimbursement of 150% of the Medicare alllowable.
Copyright © PRC Medical July 2013. All rights reserved.

2013 National Medicare Allowable:
What do I need to do?
37211 Arterial infusion $405.57
37212 Venous infusion $358.94
Since the correction will not be made until July 1, 2013 but will affect all previous dates of service, you may need to
assign modifier 50 or LT and RT and notify the payer.
Note: Your Medicare contractor will not search their files to either retract payment for claims already paid or to
retroactively pay claims. So, if you have in the past performed these procedures bilaterally and want to get
reimbursed appropriately, you would need to bring it to their attention.
In summary:
‣ Past claims:
Be proactive, if you have performed a bilateral infusion for thrombolysis on or after January 1,
2013 but were reimbursed only for a unilateral procedure, you must notify the payer. Payers will
not automatically make the correction.
‣ Future claims:
Don’t make the assumption that just because CMS made the correction to the Medicare
Physician Fee Schedule that all other payers will follow suit. Chances are they have not done so.
Be proactive, review your claims to make sure they are properly adjucated.
‣ Documentation is critical:
Due to the fact that many payers are going to require “proof” that the infusion for thrombolysis
was truly bilateral, it is imperative that your documentation individually describes each
procedure. For each infusion, your documentation must include:
Access site – name the vessel
Laterality – identify the side
Vascular system – arterial or venous
Final catheter placement – name the vessel
Identify the thrombolytic agent
Infusion time
Medical necessity
If there is a topic that you would like to see covered, please contact Wendy Block at wblock@prcmedical or by phone,
330.564.2618.
Copyright © PRC Medical July 2013. All rights reserved.