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valerieeanderson

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Hi everybody,
I have just started a new specialty in my coding career and am unsure of when to bill certain lab codes.
My physician has ordered a CBC w/ diff w/ platelet count the note does not indicate this was in-house. I can not locate the actual lab report only what the physician has documented in the encounter, so I am assuming as the family practice we would have sent this out to a lab and NOT performed it ourselves? Can someone give me their opinion based on the information given?
Also any good references to gain a better understanding of family practice coding?

Thanks so much! :D
 
Pathology and Laboratory Procedures

Hematology and Coagulation Procedures
You must code the service that was performed. Did the office perform venipuncture (36415) for the blood draw and send the specimen to an outside laboratory with the appropriate order for the test? Usually a pathologist or a technician conducts the test and provides the results of CBC to the requesting doctor.

http://www.hcpro.com/HIM-253302-859/QA-Billing-for-venipuncure-with-blood-draw.html
http://www.hcpro.com/HIM-282145-8160/QA-Coding-for-CBC-with-and-without-differential.html
http://www.healthleadersmedia.com/content/HOM-244582/QA-Correct-orders-for-lab-services.html
http://www.codeitrightonline.com/ciri/2718.html
 
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Medicare is currently denying the code 36415 for us... I am trying to find out why... However not having much luck.. This is done in an outpatient physician office.
 
Medicare Fee Schedule...

36415

This code may be used for routine venipuncture process. 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.



I found this website, thought it might be helpful...



"CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:

80048 82247 82728 83655 84450 85651
80050 82306 82784 83891 84460 85652
80051 82310 82785 84132 84550 86003
80053 82378 82947 84144 84702 86038
80055 82465 82948 84146 84703 86304
80061 82533 82950 84153 85007 86308
80069 82550 82951 84402 85013 86592
80074 82565 82962 84403 85014 86677
80076 82575 83001 84432 85018 86703
82040 82607 83036 84436 85025 86706
82105 82627 83516 84439 85027 86787
82150 82670 83540 84443 85610"


http://www.medicarepaymentandreimbursement.com/2010/06/cpt-venipuncture-36415-not-seperately.html
 
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Valarie~ Thanks so much for this info. Are they considering it a bundled charge if our office only draws the blood and sends it out to a lab?

once again, thanks so much on the finger sticks, I have been going batty trying to figure this out :)
 
Medicare pays labs only for routine venipuncture

To the best of my understanding it looks as though they might be including specimen collection in with the cost of the test. It’s hard to say without knowing the Medicare contractor and seeing the reason for denial. … If I were you I would go directly to your Medicare contractor to see what information you can gather. Also I would look at your denials to see what remark and reason codes they are assigning.
Here are some articles that might also be helpful




http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM8339.pdf





http://www.supercoder.com/coding-ne...ont-get-stuck-with-venipuncture-costs-article
 
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Hi there, if you can't find an order for lab, the venipuncture information or lab results you may need to check with the lab techinician and make sure the services was done, never assume, if is not document, do not bill. Hope this may help.
 
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