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Wiki Denial on CPT 36410

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01012688

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Stony Brook, NY
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Hi,

Has anyone had a problem with reimbursement for CPT 36410? We are being denied payment based on the diagnosis code. I would appreciate any suggestion on how to fight this and get reimbursed.

This is the response from the carrier.....

This code is only reimbursed when billed with an appropriate DX code. Disorder of vein, other or unspecified) or. (Other disorder of circulatory system),

Thanks
Eileen
 
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The first few of those dx codes I looked up don't show medical necessity for 36410. Remember this is not routine venipuncture; it is venipuncture requiring the skill of the physician. That's why they're telling you that the dx has to indicate there is some sort of disorder of the vein. Just because the physician performed it doesn't mean it qualifies for 36410; it could be 36415.
 
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