Wiki 36415 & 99000 codes

[AmandaM2153]

Hey Everyone,

So we are having an issue, where we are not getting reimbursed at all for either codes by Medicare and have even been holding up claims with other charges attached.

Now the other companies will pay for this, but is it wrong to bill those charges out to some companies if we decide to stop billing them out to Medicare??

Thank you!!!

 

[AmandaM2153]

Anyone?!?!?! I need help, I can't find it anywhere when trying to research online!!!

Thank you!!!!

 

[mitchellde]

you cannot intend to bill charges to one that you do not intend bill to all. However check the CCI edits if these bundle to any of the other codes on the claim then you can drop them.

 

[AmandaM2153]

So these charges I know for a fact are non covered codes by Medicare -- and that is our biggest payer. Do we just decide not to bill for either of those charges for all companies? I told them to do that earlier, but they just did price changes and didn't want to raise again to include the price of the draw and handling fees.
I am at a loss, I don't want to do something that isn't right, but don't want the company to have to loose all that money in the mean time!!

Thank you!!!

 

[airart]

Collection codes

Hello,

Refer to Medicare's Claim Processing Manuals.

For 36415, use G0001, Chapter 16-sections 60.1-60.9.

60.1.4 - Coding Requirements for Specimen Collection
(Rev. 1, 10-01-03)
The following HCPCS codes and terminology must be used:
• G0001 - Routine venipuncture for collection of specimen(s).
• P96l5 - Catheterization for collection of specimen(s).

For 99000, use Q0091, Chapter 18-sections 30.2-30.9.

When coding for Medicare patients, collection only of a screening Pap smear is reported using Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory. Medicare will pay for one screening every two years for low risk beneficiaries, or once per year for beneficiaries at high risk for cervical or vaginal cancer, or for woman who are of childbearing age and have had an abnormal Pap test in the past 36 months.

Complete instructions (including the full definition of “high risk� and applicable diagnosis codes) may be found in the Medicare Claims Processing Manual, chapter 18, sections 30.2-30.9.

A few private (non-Medicare) payers will accept Q0091 for collection only of a screening Pap smear. If the payer does request Q0091, ask for the policy in writing.