Wiki How to get paid on 99000?

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For the 99000 code, the only way for this to pay is if the laboratory service is not performed in the provider's office and the independent laboratory is going to bill the insurance directly for the test.

Do you have a lab in your office that you are trying to bill both the specimen collection and the handling of the specimen?

Insurance companies will not reimburse 99000 unless the description above is the scenario that you are coding for.

Hope this helps!!!
 
Amy Pritchett said:
For the 99000 code, the only way for this to pay is if the laboratory service is not performed in the provider's office and the independent laboratory is going to bill the insurance directly for the test.

Do you have a lab in your office that you are trying to bill both the specimen collection and the handling of the specimen?

Insurance companies will not reimburse 99000 unless the description above is the scenario that you are coding for.

Hope this helps!!!
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AMY - The scenario you described is the one that we are coding for. We are an in house lab and we billed with 99203 and 36415. We got a denial indicating it is bundled with one of those two but NCCI doesn't indicate that - as far as I know.
 
In this case, the blood draw was for standard sugar/protein checks for a pregnancy visit. The lab bills for their basic OB panel (e.g. 80055) and we bill for venipuncture 36415 and we bill for the transfer of the specimen to the lab 99000. We don't bill the lab.
 
Lab draws in the office

Hello,
I have two questions I need some help on.

Our providers are billing the 99000 code, which I think is incorrect. 99000 code should only be billed if our providers are handling and transporting the specimen correct?

Can our providers bill for 36415 for the blood draw in addition to the E/M service?

Thanks for the help
 
I work for an independent lab that tests UA for pain management clinics and in-patient / out-patient addiction clinics. Many of the insurances that we bill indicate that payment is not paid separately (denial code PR 234 or PR 97). The clinic is paid for the lab testing and our independent lab (who actually tests the UA) is not paid. We currently code 80307 and G0481 or G0842. Is there code or modifier that we (the lab) should be using to be paid by insurance for our testing?
 
Why is the clinic billing for a lab test that they are not doing?

80307 is a positive/negative test. If the test is positive, then the individual components and levels are identified (G0481 or G0482).

If the clinic is just collecting urine, they are billing the wrong codes.
If the clinic is using a rapid cup, they need a CLIA waiver on their claim and they should be billing 80307-GW (we haven't done these for a few years, so double-check the codes).

It sounds like the lab is either collecting and billing the test code, which is incorrect, or they are doing a rapid cup and billing incorrectly.
 
The urine is collected at the clinic and then the urine specimens are shipped to our lab where testing is done per the doctors orders. Some clinics test the rapid cup (80307) some do not. When the clinic tests the rapid cup, the lab does not test or bill for it. Mostly the denial from insurance are for billing the G0481 and G0482. What I am asking is the lab suppose to bill the 99000 or is the clinic? And if the lab bills the 99000 will that removed it from being included in the payments to the clinics?
 
Dear Amy Pritchett,

Not sure if I completely understand your explanation. I think I follow but want to make sure. Our practice (small, PCP, 5 providers) has a contracted Labcorp phlebotomist who works in our office day to day drawing our patients bloodwork and sending out to Labcorp along with our orders to be processed. So normally we don't usally any procedure codes for labs blood speciamns

However, sometimes the phlebotomist is out of office. In that case our MA staff draw the pt blood. We would like to get reimbursed for our time preforming the service(it is our staff, not Labcorp) so we would use either the 36415 or 99000. These codes are always denied for bundling. In most cases the payor says 99000 is mutually exclusive to another code. (In one case 90471) I looked up on NCCI edits and there are only 3 codes listed 99000 is incompatible with ( 36591,36592 and 96523). I am sure it is somewhere there but I can't find.

Getting back on track, sorry. So in case I described we the doctors office are collecting the speciman/bw, we hand to labcorp and they run test. That sounds like the type of scenerio which you said is only time provider gets paid for 99000. Yet I'm still not able to.

I want to educate myself to be a better coder but I'm having no luck. Would someone illuminate this for me if possible?
 
SharonCollachi said:
Why is the clinic billing for a lab test that they are not doing?

80307 is a positive/negative test. If the test is positive, then the individual components and levels are identified (G0481 or G0482).

If the clinic is just collecting urine, they are billing the wrong codes.
If the clinic is using a rapid cup, they need a CLIA waiver on their claim and they should be billing 80307-GW (we haven't done these for a few years, so double-check the codes).

It sounds like the lab is either collecting and billing the test code, which is incorrect, or they are doing a rapid cup and billing incorrectly.
Click to expand...
clia is QW not GW typo I'm sure but making sure they knew.
 
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