Wiki Patient self swabs for STI testing - how to bill

[vsmith154]

Hello fellow coders!

We have a lot of patients who self swab for STI testing and she was counseled on all methods of contraception and elected for a prescription for birth control pills.
We've been billing a 99211, 99000 and a 36415.

We are only being paid for the 36415 and the 99000, literally under $10.00.
Maybe we should bill a 99212?

Do y'all have any suggestions?

 

[sls314]

Hello fellow coders!

We have a lot of patients who self swab for STI testing and she was counseled on all methods of contraception and elected for a prescription for birth control pills.
We've been billing a 99211, 99000 and a 36415.

We are only being paid for the 36415 and the 99000, literally under $10.00.
Maybe we should bill a 99212?

Do y'all have any suggestions?

Who is seeing the patient?

99211 is a visit "that may not require the presence of a physician or other qualified health care professional." It's often used for RN visits.

Is the patient meeting with the RN, or with the physician/nurse practitioner?

I believe there may be specific codes for contraceptive counseling (99401-99404), but that's outside my area of expertise. I am not well-versed in how to use those codes and whether they'd be appropriate for your cirumstance.

 

[nielynco]

Who is seeing the patient?

99211 is a visit "that may not require the presence of a physician or other qualified health care professional." It's often used for RN visits.

Is the patient meeting with the RN, or with the physician/nurse practitioner?

I believe there may be specific codes for contraceptive counseling (99401-99404), but that's outside my area of expertise. I am not well-versed in how to use those codes and whether they'd be appropriate for your cirumstance.

And to add to your answer, we should also know why this practice is billing 99000 at all. If the patient is collecting the swab and they are only doing the labeling and leaving the sample for the lab to pick up, this code would not apply at all. I assume they are billing 36415 to get paid for taking a blood sample to be sent to the lab. And I agree, that 99211 should not be reported if they saw the provider that day rather than just the RN. And yes, if the only other service was counseling, 99401-99404 would be correctly reported for this service.

 

[vsmith154]

And to add to your answer, we should also know why this practice is billing 99000 at all. If the patient is collecting the swab and they are only doing the labeling and leaving the sample for the lab to pick up, this code would not apply at all. I assume they are billing 36415 to get paid for taking a blood sample to be sent to the lab. And I agree, that 99211 should not be reported if they saw the provider that day rather than just the RN. And yes, if the only other service was counseling, 99401-99404 would be correctly reported for this service.

I didn't even think to use the 994## series of codes! Thank you for that!
The self swab sample was sent to an outside lab. We shouldn't be billing 99000 in those cases?

 

[nielynco]

I didn't even think to use the 994## series of codes! Thank you for that!
The self swab sample was sent to an outside lab. We shouldn't be billing 99000 in those cases?

Not unless you incurred practice cost expenses over and above those you would occur doing business as a practice. Also note that 99000 has no RVUs assigned so if and when it is paid, it will be strictly payer determined. In general, 99000 was developed to take account of costs to the practice such as using your own lab equipment to prepare the sample (such as spinning it down) and then paying a lab to come get the sample (or in some cases, having office personnel take the sample to the lab). It is not intended for routine labeling of a specimen and sticking it in the lab box to be picked up. The CPT Assistant addresses this in their October 1999 CPT Assistant Q&A:

"In the Coding Consultation section of the February 1999 CPT Assistant, we addressed the use of code 99000; stating that it should be reported when the physician incurs costs for the handling and/or transportation of a specimen to the laboratory (eg, via messenger service). If the specimen is picked up by laboratory staff at no additional cost to the physician, it would not be appropriate to report CPT code 99000. While this is certainly a correct statement, many of our readers pointed out a second use of this code that is also correct, and reflects the most typical use.

Code 99000 is also intended to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory. Typical work involved in this preparation may include centrifuging a specimen, separating serum, labeling tubes, packing the specimens for transport, filling out lab forms and supplying necessary insurance information and other documentation."