Coding for 99213 with Ventipuncture 36415

[fredcpc]

The established visit by a physician came out a 99213, but a nurse did a ventipuncture to test for digoxin poisoning. Is this just a 99213, or can it be 99213-25 with 36415.

[btadlock1]

No 25 modifier s required - Just 99213, 36415. Many payers deny the 36415 as inclusive, but usually only when labs requiring blood work are billed. Just as many pay it every time, too.

[fredcpc]

So it is ok that a nurse performs the 36415, but I guess that is usually the case. But just to make sure here...the Venipuncture was to test the digoxin toxicity, or quantity. Is that still a 36415?

[btadlock1]

80162 for the lab, and 36415 for the venipuncture. They're both separately reportable with the office visit.

[fredcpc]

Thanx Brandi,
just one more question...my notes are scant here. But here the last part of the note concerning the V-punc, "Patient has been taking medication correctly. Venipuncture is is done by the nurse to assess the quantity of Digoxin in the blood. Results showed elevated digoxin. Final Dx: Digoxin Toxicity."

Is it still 99213, 36415, 80162. Dx: 972.1, E942.1. Any help??

[btadlock1]

I can't be sure of the Dx codes without my book (the internet's not always 100% accurate...still kicking myself for leaving it at work!) Buuuttt....With the notes that you've got, I'd say that you're probably correct. You want the poisoning code frst, and the therapeutic E-code second.

[fredcpc]

I know that in some Clinics, if the lab does the test, the lab bills the 80162. My notes don't really make clear whether the lab or the backoffice did the testing. any thoughts??

mahalo...

[anitha]

Hi,

Usually most of the physician offices have some facility to do the lab tests in their premises and for some, they outsource to other place. We need to ask the physician office to provide the list of in-house labs and the outsourced ones.

Anita L, CPC,CCS,CPMA

[btadlock1]

If it was sent out, you probably can't report it. Most insurers are doing away with pass-through billing, so the lab would have to bill directly for it. If you took the venipuncture, you still report that. You can also report labs that are CLIA-waived, in most cases. Check CMS's website for more information on CLIA-waived labs.

[fredcpc]

Thank you Brandi and Anita. I feel better about not coding the lab. I believe my final codes will be 99213, 36415; Dx: 972.1, E942.1.