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Blood cx and 36415

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20
Location
Clinton, TN
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0
We charge for the venipunctures and not the blood cultures, but how can we charge for two venipunctures without one being denied duplicate? We drew aerobic and anaerobic-which they have to be done from seperate areas. Is it appropriate to use a modifier and which is the best one? Or can we not charge 2 venipunctures?

Thanks
 

Kris Cuddy

Guru
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205
Location
East Lansing, MI
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0
This may be a unique situation where modifier 59 would apply. Separate service, separate site, separate reason. I would contact the carrier and find out if that would be appropriate with them, or if they would prefer another modifier or method of conveying what was done and why.

Kris
 

Kris Cuddy

Guru
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205
Location
East Lansing, MI
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Most payers still only pay one venipuncture on a DOS.
Perhaps that may be true for some carriers. Perhaps not for all carriers, or for all instances of medical necessity.

Even if that were positively factual, there is no reason why a practice cannot bill for what was done to have an appropriate accounts receivables to reflect that two services were done with one paid and one not allowed.

Billing for all services performed allows the practice to capture the true work being done, as well as correct financials of gains and losses. This is important in the scope of supporting the continued need, or additional need, for employees, as well as black and red in finance.
 
Messages
4,466
Location
Milwaukee WI
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76 modifier

76 Modifier - Repeat procedure

When you are coding the exact same CPT code within a global period (or on the same date of service for those services with -0- global days). The -76 modifier lets the carrier know that this was not an error or duplicate charge, but that, in fact, the procedure/service was performed twice.

F Tessa Bartels, CPC, CPC-E/M
 

Kris Cuddy

Guru
Messages
205
Location
East Lansing, MI
Best answers
0
76 Modifier - Repeat procedure

When you are coding the exact same CPT code within a global period (or on the same date of service for those services with -0- global days). The -76 modifier lets the carrier know that this was not an error or duplicate charge, but that, in fact, the procedure/service was performed twice.

F Tessa Bartels, CPC, CPC-E/M

Modifier 76 does appear appropriate, but it is not actually a repeat procedure. The second 36415 is being done for a completely different reason than the first. That's where modifier 59 may be the more appropriate modifier. The only reason I am posting this thought process is that this is very similar to a scenario I encountered recently and modifier 59 ended up being the accurate one to use.

It is not like performing an EKG and then performing another one a few hours later to see if the abnormality is the same or changes. With that in mind, perhaps consider the perspective that the second blood draw is not a repeat service because we are not repeating it for the same test to be done.

Perhaps it won't even matter what modifier is used. Whether 76, or 59, I would still recommend contacting the carrier and verifying if they have a preference.
 
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