ABG coding question- HELP

goldejoa

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We currently bill ABGs 82803 with a modifer 26 ( professional component) for a physicians group in an ED. They are always denied stating we do not have a CLIA number and we always end up writing them off. Can anyone help??? Is there another way that we should look at coding these? Thanks for your input.
 

eadun2000

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An MD draw for ABG is 36600. You should not be coding the laboratory code. You need to code for the procedure for the draw, which is 36600. I hope this helps.
 

goldejoa

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THanks for your response.. Can I do this still with the modifer 26 as the MD is not actually drawing the ABG, just interpreting it?
 

eadun2000

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How is the doctor reviewing it or reading it? That information should be coming from the lab and reviewing of reports, ect is part of the E&M. Who is actually drawing the ABG?
 

goldejoa

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The ED doctor is ordering the ABG- not necessiarily drawing it. He is then interpreting the results ( 2 or more components) as part of his medical decision making. This is seperate from critical care as I know this is bundled in that regard. Can I still use the professional component modifer in this instance? or should we not be billing for the ABG - I am already not getting paid for it as an 82803 #26. I was looking to remedy that situation for our billers.

Thanks for your help and response.
 

eadun2000

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Then that would be part of the E&M. He should not be trying to bill for reading the ABG. He is reviewing the report from the lab, the same way as he would read a normal CBC, cardiac enzymes, ect.
 
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Hi,

Just checking but isn't 82803 a clia waived test? Billing it with a QW would make it "payable", if all other coding and reporting guidelines are met of course. I see that you have a dialogue going with another fellow coder but I thought I'd just interject the info on the QW modifier. Hope it helps!
 

goldejoa

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thanks for your reply.. this is all so new to me...

I was teetering on asking the question about clia waivers.... Do I need to have the physicians group file for a clia waiver ? or do I just use the QW modifier ( which until now I did not know existed so thanks!:).. I am not convinced about having the ABG covered by by E/M. Why would this be any different than an EKG interpretation (93042)?

I hope I am not opening Pandora's box on this, but am just trying to get it correct.

thanks
 
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