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ABG coding question- HELP

  1. Question ABG coding question- HELP
    Medical Coding Books
    We currently bill ABGs 82803 with a modifer 26 ( professional component) for a physicians group in an ED. They are always denied stating we do not have a CLIA number and we always end up writing them off. Can anyone help??? Is there another way that we should look at coding these? Thanks for your input.

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    An MD draw for ABG is 36600. You should not be coding the laboratory code. You need to code for the procedure for the draw, which is 36600. I hope this helps.

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    THanks for your response.. Can I do this still with the modifer 26 as the MD is not actually drawing the ABG, just interpreting it?

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    How is the doctor reviewing it or reading it? That information should be coming from the lab and reviewing of reports, ect is part of the E&M. Who is actually drawing the ABG?

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    The ED doctor is ordering the ABG- not necessiarily drawing it. He is then interpreting the results ( 2 or more components) as part of his medical decision making. This is seperate from critical care as I know this is bundled in that regard. Can I still use the professional component modifer in this instance? or should we not be billing for the ABG - I am already not getting paid for it as an 82803 #26. I was looking to remedy that situation for our billers.

    Thanks for your help and response.

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    Then that would be part of the E&M. He should not be trying to bill for reading the ABG. He is reviewing the report from the lab, the same way as he would read a normal CBC, cardiac enzymes, ect.

  7. #7

    Just checking but isn't 82803 a clia waived test? Billing it with a QW would make it "payable", if all other coding and reporting guidelines are met of course. I see that you have a dialogue going with another fellow coder but I thought I'd just interject the info on the QW modifier. Hope it helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  8. Default
    thanks for your reply.. this is all so new to me...

    I was teetering on asking the question about clia waivers.... Do I need to have the physicians group file for a clia waiver ? or do I just use the QW modifier ( which until now I did not know existed so thanks!.. I am not convinced about having the ABG covered by by E/M. Why would this be any different than an EKG interpretation (93042)?

    I hope I am not opening Pandora's box on this, but am just trying to get it correct.


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