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labwork not sent

  1. Default labwork not sent
    Medical Coding Books

    If a patient had bloods drawn (ordered by the doctor) and then refused to have them sent out to the lab, are we allowed to code/bill for the blood draw? We held onto the bloods for 10 days but did nothing with them.

    Another situation: the doctor removed a sample of a skin lesion but it was "insufficient for submission to laboratory not submitted." Are we allowed to bill for the biopsy? Is modifier 22 appropriate here?

    Thank you very much for your help.

  2. #2
    Default labwork not sent
    If your facility did the draw and the patient refused to allow it be a send out then yes you may charge the venipuncture. Your team did the work by drawing the blood - however you may be denied by the patient's insurance carrier because no labs were charged to support the VEN being done.
    Quick thought or idea - off the top of my head couldn't you use the V code for non compliant patient because the doctor ordered them, but patient refused to allow them to be processed? Also you may want to send the claim with the supporting documentation for processing.

    The doctor removed a sample of a skin lesion but it was "insufficient for submission to laboratory not submitted." - no we can't bill something like this out, because nothing was done due to there being no specimen. They opened the specimen container to find it was empty.

    Modifier 22 is for increased procedural services and would not be appropriate.

    Dana Chock, CPC, CANPC, CHONC
    Anesthesia, Pathology & Laboratory Coder

  3. Default
    Thank you for your reply. I meant to take the modifier 22 question out after looking it up.

    Would the V code be linked to the specimen handling 99000?

    I am not understanding why the biopsy can't be billed. There was a small specimen but the doctor deemed it insufficient in terms of sending out to the lab. Is this different than the bloods since the biopsy itself was insufficient?

    Thank you again for your help.

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