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Wiki 36415 Billed with Lab Procedures

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rfarnham91

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Is it possible to bill 36415 with various lab codes (examples are 84207, 84425, 84443, 80053, 82746). I have been working Harvard Pilgrim denied claims and a major thing I have noticed is that there are multiple denials for this situation. I did look at HPHC's policy which states "Venipuncture charges (collection of blood) made in conjunction with blood or related laboratory services or evaluation and management services when reported on the same day by any provider reporting the same Federal Tax ID Number (TIN)."

Does this mean we would have to adjust 36415 AND lab procedures or would it be just 36415?
 
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While I'm not familiar with Harvard Pilgrim, many payors will bundle 36415 into basically any other service provided that day, even if not NCCI edits.
When I read the policy, it states they will not pay for venipuncture (aka 36415) when billing for laboratory services. Your LABS would still be payable (assuming they are not bundled, justifying dx, etc.
 
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