Wiki Venipucture Coding

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mistypace

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Oxford, AL
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Looking for advice. Can you charge for a venipuncture when blood is drawn for in house labs? If so, where can I find documentation to print out. I reached out to other coders and researched through AAPC website. All the research shows you can charge for a venipuncture when blood is drawn for labs done in the providing and when labs are sent out. The billing department does not agree with this and are questioning it. Any help and advice is welcomed. Thanks.
 
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The reimbursement for a venipuncture is approximately $3.00, and as this discussion shows, some payers have policies under which it is not even reimbursed at all. In other words, even if it gets paid, it barely covers the cost of the postage, paper, envelope and ink needed to send a claim, let alone the time spent doing it. Given this, it is quite possible that coding and submitting your venipuncture charges could cost more in the extra work in managing the claims and denials it creates for your practice than it can regain in additional reimbursement. It's entirely appropriate and reasonable that your management make the business decision to not code or bill these if they have determined that is the case.

Think of it this way - at $3.00 each, how many of these charges would have to be paid to offset just the time that coders have spent reading, researching and typing the 13 posts so far just on this one forum thread? :)
 
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A venipuncture is always billed in-house or send out labs for the collection of venous blood by venipuncture. That's an extra revenue that you don't want to miss, however there are some carriers who would not pay for a veni.
 
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Answering on the provider (Part B billing) side: Yes, you can charge for the venipuncture for specimen collection as long as it's appropriately documented. What is your billing department basing their argument on? It sounds like they're received denials from one of the payers who won't reimburse it when any other service is performed.
 
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The billing supervisor is stating a venipuncture can only be charged on send out labs not in-house labs. One of the other billers and I agree that we can charge for it. I also explained that we can charge for a finger stick on a toddler as well. What is the best way to appropriately document it? This way I can pass the information to the billing supervisor, our physician and office manager.
 
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We usually just had some notation in the chart (usually the scanned order with handwritten notes by the phlebotomist) of the number and types of vials drawn. Nothing complicated. You just need to be able to prove you did the service you're billing for.
 
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We have the labs ordered in the chart with results as well depending on the type of lab test. The charts do not specifically state the labs were obtained via venipuncture/finger stick. All the nurses in our clinic draw blood from the patient not just a specific lab tech or phlebotomist.
 
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I would say it doesn't matter who is doing the draw as long as they are permitted to do so per their licensure. To go back to your original question, it does sound like the Billing Manager is making a blanket decision based on some denials. You're likely not going to find any supporting documents that say yes, you can bill this. Look for reimbursement policies that say "this is when you can't bill this code". As mentioned above, some payers always bundled the venipuncture code with other services on the same day but I haven't heard it's all payers.
 
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mistypace said:
Looking for advice. Can you charge for a venipuncture when blood is drawn for in house labs? If so, where can I find documentation to print out. I reached out to other coders and researched through AAPC website. All the research shows you can charge for a venipuncture when blood is drawn for labs done in the providing and when labs are sent out. The billing department does not agree with this and are questioning it. Any help and advice is welcomed. Thanks.
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You might reference Chapter 16 Section 60.1.1 of the Medicare Claims Processing Manual and/or payment policies posted by some of the health plans in your area. As others have said, there have probably been some denials in the past. I do feel that there should be sufficient documentation to support who drew the specimen, the site and method, and a brief assessment of the site/patient reaction that is signed with credentials and preferably points back to the physicians order for the test (especially if drawn on a date prior to or after a visit). Cindy
 
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Cynthia Hughes said:
You might reference Chapter 16 Section 60.1.1 of the Medicare Claims Processing Manual and/or payment policies posted by some of the health plans in your area. As others have said, there have probably been some denials in the past. I do feel that there should be sufficient documentation to support who drew the specimen, the site and method, and a brief assessment of the site/patient reaction that is signed with credentials and preferably points back to the physicians order for the test (especially if drawn on a date prior to or after a visit
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In our charts we document when pt is here for fasting labs with medication refills and/or lab only. There is a section that shows what procedures and tests were ordered and results for the ones that had results that day. Do we have/need to add documentation stating for example Blood drawn via vein in right or left arm with initials of person who drew the blood? We use hand written face sheets as well as electronic charts. The hand written face sheet usually has the initials of the person who drew the blood. Also, if we draw blood for labs we can run in our office as well as send out labs for other tests that our office is not able to process. Would we/I need to add Mod 90 to the 36415 code if we run labs in house as well as send out labs? I just need as many details as possible when going back to the billing supervisor and office manager to further discuss charging this. Thank you so much.
 
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We used the scanned copy of our hand written order/follow-up sheet with the same info (# of tubes drawn, initials of who drew it) if we needed to support the draw code so if you have that, I would think you're good. If any abnormality was noted, there was usually a separate note placed in the chart as documentation. The office often did a draw with certain labs in house and others were sent out that we were not able to perform internally. We charged one draw and did not use any modifier on 36415. Again, we only had problems with reimbursement for those plans that had reimbursement policies preventing 36415 from being paid separately. I don't recall the venipuncture ever bundling with a lab CPT when only the draw and labs were performed.

I've never worked in an office where a -90 mod was applicable but it's my understanding that is only reported on the lab codes and only if there is an arrangement where the office pays the outside lab for the test performed and the office then submits the bill to insurance. If the outside lab is billing the patient's insurance directly for payment, -90 would not be appropriate to use on any codes submitted by your office.
 
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Thank you everyone for all your help. The consensus among all the billing department is that I can't code and bill for the 36415 venipunctureor the 36416 finger stick codes. There are 2 of them have stated that it is double billing and it looks bad on audit trails for labs we process and run in our office laboratory. I have printed out manuals from different payers that state we can in fact bill it with in house labs but the billing department states we can't.
 
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I completely understand your point of view. Thank you!
We discussed it again and decided that I will print out the provider manuals for the insurances to be reviewed by all of us together. I believe there are few that will pay for it. I explained that maybe I am misinterpreting the manuals or not fully understanding the way they have worded them. So they will review it and we will all get back together to further discuss.
 
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thomas7331 said:
The reimbursement for a venipuncture is approximately $3.00, and as this discussion shows, some payers have policies under which it is not even reimbursed at all. In other words, even if it gets paid, it barely covers the cost of the postage, paper, envelope and ink needed to send a claim, let alone the time spent doing it. Given this, it is quite possible that coding and submitting your venipuncture charges could cost more in the extra work in managing the claims and denials it creates for your practice than it can regain in additional reimbursement. It's entirely appropriate and reasonable that your management make the business decision to not code or bill these if they have determined that is the case.

Think of it this way - at $3.00 each, how many of these charges would have to be paid to offset just the time that coders have spent reading, researching and typing the 13 posts so far just on this one forum thread? :)
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And why would you charge 36415 multiple times if you didn't "stick" the patient multiple times?
 
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