Wiki Billing a 99211 & 36415

[mringlein]

Our practice bills a 99211 and 36415 to our payers when a patient comes in for a blood draw. Our nurses do take a blood pressure and chart any complaints patient may have. About a month ago, Medicare started denying the 99211 saying " this service requires that a qualifying service/procedure be received and covered. Not covered when performed during the same session/date as a previously processed service for the patient. " Now our other payers are following. We do use the same diagnosis for the 99211& 36415. Can anyone help and let me know if I need a modifier or anything or if the 36415 is all we will be reimbursed for.
Thanks in advance!

 

[rthames052006]

Our practice bills a 99211 and 36415 to our payers when a patient comes in for a blood draw. Our nurses do take a blood pressure and chart any complaints patient may have. About a month ago, Medicare started denying the 99211 saying " this service requires that a qualifying service/procedure be received and covered. Not covered when performed during the same session/date as a previously processed service for the patient. " Now our other payers are following. We do use the same diagnosis for the 99211& 36415. Can anyone help and let me know if I need a modifier or anything or if the 36415 is all we will be reimbursed for.
Thanks in advance!

You shouldn't be billing both codes for the blood draw visit. I know my local MAC has information on their website regardign this topic. I would suggest you check with your local Medicare carrier and other carrier policies as well.

I have checked with several of my carriers and they are following the same thing.

Good luck!

 

[MarcusM]

From the AAPC coder for 36415: "Some payers cover a separate blood collection fee, and some don't, so you'll need to check with individual payers. Medicare will pay for blood collection by venipuncture, but not fingerstick, while some payers cover both. Still others consider the blood collection service bundled with the lab test."