Venipunctures

sec5188

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We've had an increasing amount of denials for code 36415 with a 90 modifier. We are billing this code when we draw blood to send to our reference lab. Is this incorrect? Is anyone else having this problem? Currently, the problem is exclusively with Aetna and Humana.

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Sondra
 

mitchellde

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the code is suppose to go on the lab codes when you are billing the labs but sending them to an outside lab for procesing. This is what I have found as the definition for the 90 modifier.
 

sec5188

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That's what I was thinking. I guess my follow up question is...the reference lab is the one who bills the insurance for the labs so if I bill the lab with a 90 modifier and the reference lab bills the lab also, the patient is being billed twice...What are we supposed to bill if they just come in for a blood draw and the labs are sent out?
 

mitchellde

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If the lab is billing for the test then you bill only for the venipuncture with no modifier. Some payers will pay this if it is the only code if it is with an office visit then most will bundle this with the OV.
 
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