Billing E/M with modifier 25 and 36415

cpicerno

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Hi!! I was recently advised to bill an E/M level with a 25 modifier with a 36415 (blood draw). I'm not sure if this is correct. Can anyone give me any info as to whether this is appropriate?? :confused:
 

mitchellde

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Was this a visit for the blood collection? If so then no. If the blood collection was a decision during the encounter then technically yes but most will bundle it into the visit level anyway.
 

cpicerno

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I work at a pediatric urgent care facility and most of the time the child will come in with a high fever or some other problem and we decide to do a CBC or some other test....
 

mitchellde

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If you run the test in house they will bundle the draw into the test, if you send it out they will bundle it with the visit most of the time. I usually bill it anyway when it was not the reason for the visit.
 

mitchellde

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If you send it to an outside lab you would not bill the 85025 unless you pay the lab and they do not bill but then you need a 91 modifier on the lab
 
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