Wiki Billing E/M with modifier 25 and 36415


Brandon, FL
Best answers
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:
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.
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....
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.
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