Wiki 36416

[KimKrebs]

I was curious if anyone gets paid for this code when billing with 85025 from BCBS or Aetna. It gets separately reimbursed by UHC, Golden Rule, UMR and a couple other smaller insurance companies.
I did not know if was worth trying to use a modifier 59 for BCBS. We typically do a Finger-stick/CBC for every annual wellness exam, and the allowed amount is around $5 and 90% of our patients have BCBS, so it could be worth trying if anyone else has had luck.

Thanks!

Kim, CPEDC

PS: I did call BCBS and they told me that it was bundled due to primary E/M service, but I could appeal the claim with documentation.

 

[erjones147]

I have never seen 36416 paid, so we gave up trying - it just didn't seem worth the low reimbursement

You have a fingerstick CBC machine??!! Is a CLIA-waived device?

I would be very interested in that for our clinic - can you post the machine info so I can research it online?

 

[CodingKing]

36416 is a CMS status B (always bundled) unless its one of the odd payers that don't apply any medicare logic (since most commercial payers follow CMS to the most part).

 

[KimKrebs]

I have never seen 36416 paid, so we gave up trying - it just didn't seem worth the low reimbursement

You have a fingerstick CBC machine??!! Is a CLIA-waived device?

I would be very interested in that for our clinic - can you post the machine info so I can research it online?

Yes! It is a DREW3 from Drew Scientific Inc; I know we ordered it through McKession. I'm not sure if it is Clia-waived. Our model is about 6 years old. Hope that helps!