Wiki Need helpm with billing 99205 and 36415

[mauadajar]

Hello. If I am billing 99205 for a new Pt and the medical assistant did a blood draw for Cancer Screening, do I bill 99205,25 and 36415? I am getting mixed information about this. Some people said to not use a modifier, some people said use 25. I also saw one post that they use 90. A claim got sent back to our EMR stating modifier mismatch.We billed 99205,25 and 36415.

 

[lgardner]

no modifier is required for this.

 

[mauadajar]

Thank you for your response. I will redrop the claim

 

[mauadajar]

So, I dropped the claim that I mentioned about last time. It was for Aetna Better Health. It came back and it said the same thing, This procedure code is inconsistant with the modifier used or a required modifier is needed .

I billed 99205 and 36415 without any modifier. I got the same denial. Does any of you know what modifier I should be using?

Thanks

 

[mitchellde]

They are more than likely wanting to bundle the 36415 into the E&M. However what dx codes did you use and how did you link them.

 

[mauadajar]

they are more than likely wanting to bundle the 36415 into the e&m. However what dx codes did you use and how did you link them.

99214- 621.2, 626.2, 626.8, 625.9

36415- 61172, v1641, v163

 

[AKALLOO]

99205 and 36415

There is no modifier needed when billing an office visit with venipunture. I review E & M services and bill for the venipuncture and never was there a denial. Just make sure you are linking the correct diagnosis.

 

[philipwells]

In my experience with billing 36415 to different commercial insurers, some payers require modifier 90 on the 36415 and others require modifier 33 on the 36415.

Never bill a 25 modifier on the office visit with most all labs, IE your 80000 series codes.

 

[Edithcha]

So which modifier should be used for a complex patient who needs lab work but not necessarily as preventive (i.e. AIDS patient) ? 99205-25, 36415?

 

[jademound]

No Modifier

I bill these 2 charges to commercial payers on a daily basis. We do not use a modifier on the claim. Just bill the 99205 & 36415. Do you also have lab charges on the claim, or is it just the draw fee? Our lab charges go on the claim with the draw fee.