36415 and Q0091 denials

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I am looking at a lot of claim denials from anthem here in Va for 36415. Example 99214, 36415.
Also 99397, Q0091 (together)
99213, 99000 (together)
Many denials for the 36415.
I’m new to Primary Care, my specialty is Gastro.
Can anyone give me guidance as to why she is getting all these denials from Anthem?
 
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I am looking at a lot of claim denials from anthem here in Va for 36415. Example 99214, 36415.
Also 99397, Q0091 (together)
99213, 99000 (together)
Many denials for the 36415.
I’m new to Primary Care, my specialty is Gastro.
Can anyone give me guidance as to why she is getting all these denials from Anthem?
I believe that CPT code 36415 when billed with an E&M service is not separately reported, the 36415 would be considered part of the E&M - I don't think you can report 99000 (handling of specimens) for separate reimbursement.
 

csperoni

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Selden
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Yes, some insurances will bundle 36415 or Q0091. It may not be a CCI edit, but rather a carrier policy.
I don't think there are any insurances that pay for 99000 separately to a provider's office.
 
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I believe that CPT code 36415 when billed with an E&M service is not separately reported, the 36415 would be considered part of the E&M - I don't think you can report 99000 (handling of specimens) for separate reimbursement.
Is there an alternative so that she can do these in the office, send the draw out to Labcorp and get paid? Or just do it in the office, but stick with not reporting it because we won’t get paid?
I know it will be a lot of write offs if we keep this up.
 

SharonCollachi

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Why spend your time on blood draws in the office when it takes so much time with denials and writeoffs? Why not just put the lab order in and have the patient go to the lab?
 
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