Wiki 36415 and Lab CPT codes rebundling - procedures are incidental

[Anduiza05]

I am on the payer side and I noticed that we deny 36415 with all lab codes stating that it is incidental to the lab work. I know most payers do not pay but as a coder I want to know where in the coding guidelines it states that these procedures are incidental. I checked the CCI edits and they are not bundled.

 

[kevbshields]

You won't find it anywhere but in the payer edit logic. While I agree that, to some extent, you cannot obtain a blood specimen and use it to perform a lab, it still required some level of skill and generates a "charge." I believe Medicare and one other federal payer remit a nominal amount for this service.

 

[davidsnk]

It shouldn't be denied. It is not incidental to the actual test performed. I have never had a payor deny the 36415 with the lab codes until just recently.
Now we have one Medicaid HMO wanting to deny them.

It is not a bundled code and it's a separate service requiring a skilled technition to draw the blood.
The blood then may be run at the place of the draw, or the tubes can be sent out to a reference lab.

Quite a few insurance companies now require outside labs be used, so the office has to pay a lab tech to draw blood/tubes on all the patients and send them out.
Where is their compensation if only the actual lab run test is paid to the outside reference lab?

 

[wannabecoder]

I have worked for 3 different commerical payors and none of them ever paid for the venipuncture as a payor decision. However, last year my recent employer-a payor is now paying a nominal fee without having to use modifier-90. You might see if using modifier -90 will allow the charges, of course if you used an outside lab for processing.