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Pediatric Coding Alert

Extend 99000 to Specimen Prep, Regardless of Shipping Fee

Published on Fri Mar 13, 2009

Think you can use 99000 only when your practice incurs a transportation charge? Truth: Start collecting from private payers for pre-transport prep work to an outside lab after you check out the code's CPT guidelines.

Count Specimen Preparation Under 99000

You can report 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) for the preparation of a specimen for lab transport to an outside lab, even when there is no cost incurred for pickup and transport of the specimen for processing, assures Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, manager at Pershing Yoakley & Associates, P.C. in Clearwater, Fla.

Specifics: "The work involved by the staff/physician in preparing the specimen (centrifuge, labeling, packaging, completing lab slip, etc.) meets the requirements for appropriate reporting of this handling code," Mac says.

Check Out the AMA's Clarified View

If you scream, "But, wait! I've been told I can only use the code for incurring a cost," be aware CPT promulgated this view.

The AMA, in the Feb. 1999 CPT Assistant, noted that 99000 "is intended to be reported when the physician incurs costs to handle and/or transport a specimen to the laboratory (e.g., via messenger service). If the specimen is picked up by laboratory staff at no additional cost to the physician, it would not be appropriate to report CPT code 99000."

Don't miss: In the Oct. 1999 CPT Assistant, the AMA did a 180°, retracting the above opinion and clarifying 99000's use.While using 99000 for incurring a transport cost is certainly a correct statement, "many of our readers pointed out a second use of this code that is also correct, and reflects the most typical use. Code 99000 is also intended to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory. Typical work involved in this preparation may include centrifuging a specimen, separating serum, labeling tubes, packing the specimens for transport, filling out lab forms, and supplying necessary insurance information and other documentation."

Example: For a venipuncture in the office, a physician uses 36415 (Collection of venous blood by venipuncture). "In addition, code 99000 should be reported when the physician's office centrifuges the specimen, separates the serum and labels, and packages the specimens for transport to the laboratory," according to CPT's clarification comment.

Assign 1 'MDM' Point for Lab Order

For private payers that follow Medicare's policy and bundle 99000 into the day's service, consider the collection work in the E/M's medical decision making (MDM).

The standard CMS auditing sheet gives one point under "Amount and/or Complexity of Data Reviewed" for ordering a clinical lab test. "He receives only one point, no matter how many labs he orders," cautions Donelle Holle, RN, principal of PedsCoding.com in Fort Wayne, Ind.

The point could in turn affect the type of medical decision making, which could potentially increase the level of E/M service (99201-99215, Office or Other Outpatient Services) selected.

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