Wiki How to put E&M codes and labs together

[ccatron]

We are trying to transition from a free clinic to a billing clinic. On the superbill the E&M codes and all the labs that were drawn that day are all listed. Then we bill 36415 for the lab draw. The labs are sent out so they are marked not billable on the superbill. Should we be adding modifier 25 since there are two procedure codes for that day? Any thoughts would be helpful.

Thanks,
Christy
CPC

 

[MarcusM]

http://www.aafp.org/fpm/2000/0700/p23.html
offers this information:

Lab specimen transportation
Q: Can you explain the proper use of CPT code 99000? How does it relate to specimen collection, lab codes and venipuncture?

A: CPT code 99000, “Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory,” is intended to be reported when the practice incurs costs to handle and/or transport a specimen to a lab. For example, if the practice employs a messenger service to transport a specimen, that service can be coded using 99000. In comparison, if lab staff pick up a specimen at no additional cost to the practice, it would not be appropriate to report code 99000.

Code 99000 also is not intended for reporting the obtaining of a specimen. Reimbursement for obtaining a Pap smear or a throat culture is factored into the relevant lab procedure code. Obtaining a blood specimen by venipuncture may be reported separately, using code 36415, “Routine venipuncture or finger/heel/ear stick for collection of specimen(s).”

 

[kelseyhill26]

We add modifier 25 to separate the office visit from the blood draw as most insurance's consider the blood draw a procedure.

 

[pezztx]

It has been my experience that a modifier -25 is not required for a VP with an E/M service. Also, we do not charge 99000, as we do not employee the courier that picks up for outside labs, that would be that lab's responsibility to bill the patient for.