1. R

    Question Colonoscopy w/ Snare Biopsy - missing path

    When working a procedure where the documentation supports 45385 but the resulting lab sample is lost - is the procedure still coded snare biopsy? How does this effect dx?
  2. M

    When to bill for FIT test

    Hi all, Our clinic has recently started doing FIT tests. My question is, do we bill for the test when the patient is given the kit or wait until the patient brings it back? Sometimes the patient never returns with the kit and I don't feel like we can bill for that since the test was never...
  3. T

    Pathology Coding

    Hi fellow CODERS! I hope this message finds you well. I am in need of some clarification around lab billing. I am not very familiar and would like to get some feedback. our office is billing multiple CPT codes in the Microbiome area. One being 87798, as we know this is an unlisted code...
  4. R

    86235 to be billed with modifier 59,91 or QW

    As a diagnostic test lab, we are supposed to bill 86235 8 times for a test. My question is which modifier I should use? I have heard mixed info about using 91,59 or QW. Can some one please advise, which modifier I can use and why there are different modifiers? Thanks in advance, Amer
  5. C

    Urinary Drug Testing

    Does inconsistent lab results warrant an upcoding in the definitive CPT code? Ex: if we tested 7 drug classes (G0480) and the patient tested positive on 5 of those classes in which we performed additional testing to test the quantity, does that warrant a G0481 due to the additional testing?
  6. C

    Urinary Drug Testing

    Does inconsistent lab results warrant an upcoding in the definitive CPT code? Ex: if we tested 7 drug classes (G0480) and the patient tested positive on 5 of those classes in which we performed additional testing to test the quantity, does that warrant a G0481 due to the additional testing?
  7. C

    When all the procedures don't fit on the claim form

    Good morning everyone, I've been an avid reader of the forums for some time and would appreciate some advice on a thorny work situation. The practice I work for has decided to change up some of the lab testing. The problem is what they want to change it to is basically 3 components short of a...
  8. K

    Hospital Code for Venipuncture Perfomed in Lab

    Hello, We code for a hospital who has an in-house lab. Occasionally patients will get their venipuncture done at the lab instead of in the clinic. Are we able to code for the 36415 under the ordering physician even if the provider didn't draw the blood? Thank you, Krystal
  9. C

    Provider and place of service for Lab

    I am new to Lab and am trying to resolve some inquiries that I am baffled on. We are going to have a draw station in a separate suite location-not in but near our Medical group office, the specimens will be sent to our hospital lab to perform the tests, and then they are requesting that the...
  10. M

    86592 Chlamydia

    A patient was seen at our family care office. He had been told by the health dept that he may need to be treated a second time for chlamydia. Our dr ordered 86592. Test results were negative. Am I able to code z11.3 since we are looking for the infection again? If not, what can I use? I...
  11. S

    Downcoding Lab Services

    We are an independent lab. Humana and Cigna now have policies in place that they will not reimburse any higher than a G0480 tox for Humana and a G0481 tox for Cigna. What Cigna does is downcode when they reimburse and Humana pays the higher tests than recoups a couple months later and we have to...
  12. A

    Z code sequencing

    Hello, I'm a coder for a diagnostic lab facility that specializes in cardiovascular and endocrine disease prevention. On our test requisition forms physicians are required to check off codes we have listed as indicators, or they may write in codes that are not pre listed on the form. I am only...
  13. S

    PLEASE HELP!!! 87481 with Multiple UNITS!!! ( PAP ) (Candida)

    PLEASE HELP with any information or advice on what to do!! We have been billing code 87481 with 4 units and the insurance companies are only paying for 1 unit. We have billed with modifier 91 trying to get multiple units paid but just gets denied with that modifier. Multiple Ins. companies...
  14. B

    INR testing @ Lab

    Good morning! One of my physicians asked an interesting question. She was wondering if we can bill/charge for reviewing and medication management for a patient who has their INR drawn at a Lab or draw station, not in our office. The lab or patient will call our office with the result, then...
  15. Walker22

    Definitive Drug Testing for Cigna

    Cigna has recently released a drug testing policy that allows 8 definitive tests per date of service. Due to this limitation, they have determined that G0482 and G0483 are not medically necessary (because both codes exceed the 8 test maximum) and not payable. My lab now has a coding dilemma: 1...
  16. D

    Venipuncture - Why do some of the Medicare

    Why do some of the Medicare advantage plans deny a routine venipuncture? Specifically Coventry. I have one patient that come into the office for regular lab draws and I am having issues getting the 36415 to be paid. Help please?! Thanks.
  17. Y

    Collecting an specimen to send to outside lab

    Hi: Is correct to bill 99000 for any specimen that goes to outside lab? We only bill it once per day per patient even if more than one specimen. Our outside lab provides supplies and picks up specimens. Our staff does "handle" the specimen and prepare it for transport. Which code can we use to...
  18. M


    Patient was seen in office 2/1 labs drawn office visit and injections billed, lab calls at end of day with critcal lab values and patient is called to told to present to ER for admission, patient waits until 2/2 and comes back to office and JUST picks up admission orders, physician does not see...
  19. T

    99211 hep c patient visit

    Can the nurse charge 99211 for established patients each time they come in for accessment and then sent off to lab for blood test? The lab is outside lab but patients come every so often see the nurse first.
  20. L

    Urine Drug Screen billing for Monitoring in a Residential Substance Abuse Setting

    Can someone help on guidance for UA's that are sent to an outside lab for processing? The requisition is marked for the monitoring of suspected substances and included with specimen. Is it appropriate for us to bill for these services if we pay the lab directly for furnishing the supplies and...
  21. S

    No billing for Pap smear

    I have an np that wants to bill for Pap smear. What code should we use and can we bill with an office visit? We send the pap out to the lab.
  22. A

    Humana Denial

    Is anyone having trouble with Humana not paying office visits, even with a mod 25 attached? These are all being denied in our office and bundled with lab services or vaccines. Does anyone have any thoughts are how to correct?
  23. A

    2016 Medicare Tier Pricing/ Other Insurances

    I am trying to find out what insurances have decided to follow CMS and their Tier Pricing for 2016? I have spent the past few days contacting insurances, however most of them are either clueless, or just tell me that they're not making any changes "as of yet" After a nightmare in 2015 with...
  24. D

    TSH denials from medicare

    Hello! I work for a neurologist who regularly orders thyroid stim hormone assays (CPT 84443) in conjunction with other tests to check for Peripheral neuropathy after a trans ischemic attack or a stroke. The tests that come back abnormal are being paid, but we have 3 that came back normal that...
  25. L

    Lab RAST testing

    I don't normally do lab's and have a physician who wants to know how to code a comprehensive RAST according to labcor, though they couldn't tell me why we should use 86003(x9) and 86005. I don't see the difference in these codes and one says RAST so why the two codes combined for the one test...