jbhuju
Guru
a quick question regarding 87635 cpt code. if patient was done covid test ( 87635) but result was invalid do we still bill insurance with any modifier? please help.
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Wiki 87635
- Thread starter jbhuju
- Start date
jbhuju
Guru
inefficient swab collection for the result.
I guess it depends on the clinic, but if swab wasn't good and it was our error in the collection, I'm pretty sure our clinic wouldn't bill the patient for it at all. I'd double check with the clinic manager (in my billing world), but in the past our clinic has emailed me stating to not bill out certain labs due to internal errors with samples.
jbhuju
Guru
thank you for clarification 
danachock
Expert
Hello jbhuju and ksobota
I have something to state on this, what are you REALLY going to bill? If you reviewed the NCCI edits, prove me if I am wrong, but I am thinking that from the NCCI edits "that there is "NO VALUE", the laboratory test simply failed; with no blame placed on anyone - BUT if you are faced with an honest RAC audit or "you need to send your notes to support billing this" because whatever happened., It is NOT going to be reimbursed. My assumption ~ it is probably A BIG NO if you are faced with providing notes. No reimbursement.
I'm not kidding here. The test "failed" but I already know that the healthcare facility is asking them (our patient) to return. They are already asking the patient to come back and "simply retest". Again, I am not about penalizing on what went wrong with this scenario, but what is going on here to provide NCCI guidance. As a pathology coder - please review what I did. Did you see an opportunity to bill this charge? In MY OPINION the documentation to prove that we should bill that charge simply isn't billable. Anyone that wants to challenge me you review the NCCI edits and tell me and all of us (our pathology colleagues) on how to bill this correctly please.
Yes ~ I wholeheartedly agree that we would all like to be paid for all of health care facilities services performed, but sometimes it clearly isn't possible.
Research this please and respond with your findings and have a fantastic evening!
Dana
I have something to state on this, what are you REALLY going to bill? If you reviewed the NCCI edits, prove me if I am wrong, but I am thinking that from the NCCI edits "that there is "NO VALUE", the laboratory test simply failed; with no blame placed on anyone - BUT if you are faced with an honest RAC audit or "you need to send your notes to support billing this" because whatever happened., It is NOT going to be reimbursed. My assumption ~ it is probably A BIG NO if you are faced with providing notes. No reimbursement.
I'm not kidding here. The test "failed" but I already know that the healthcare facility is asking them (our patient) to return. They are already asking the patient to come back and "simply retest". Again, I am not about penalizing on what went wrong with this scenario, but what is going on here to provide NCCI guidance. As a pathology coder - please review what I did. Did you see an opportunity to bill this charge? In MY OPINION the documentation to prove that we should bill that charge simply isn't billable. Anyone that wants to challenge me you review the NCCI edits and tell me and all of us (our pathology colleagues) on how to bill this correctly please.
Yes ~ I wholeheartedly agree that we would all like to be paid for all of health care facilities services performed, but sometimes it clearly isn't possible.
Research this please and respond with your findings and have a fantastic evening!
Dana