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How to get paid on 99000?

  1. #1
    Question How to get paid on 99000?
    Medical Coding Books
    Is 99000 always included in E/M codes? Is it reimbursable under any conditions?

  2. #2
    Default
    For the 99000 code, the only way for this to pay is if the laboratory service is not performed in the provider's office and the independent laboratory is going to bill the insurance directly for the test.

    Do you have a lab in your office that you are trying to bill both the specimen collection and the handling of the specimen?

    Insurance companies will not reimburse 99000 unless the description above is the scenario that you are coding for.

    Hope this helps!!!
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. #3
    Default
    Quote Originally Posted by Amy Pritchett View Post
    For the 99000 code, the only way for this to pay is if the laboratory service is not performed in the provider's office and the independent laboratory is going to bill the insurance directly for the test.

    Do you have a lab in your office that you are trying to bill both the specimen collection and the handling of the specimen?

    Insurance companies will not reimburse 99000 unless the description above is the scenario that you are coding for.

    Hope this helps!!!
    AMY - The scenario you described is the one that we are coding for. We are an in house lab and we billed with 99203 and 36415. We got a denial indicating it is bundled with one of those two but NCCI doesn't indicate that - as far as I know.

  4. #4
    Default
    What laboratory service were you billing to the outside lab?
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  5. #5
    Default
    In this case, the blood draw was for standard sugar/protein checks for a pregnancy visit. The lab bills for their basic OB panel (e.g. 80055) and we bill for venipuncture 36415 and we bill for the transfer of the specimen to the lab 99000. We don't bill the lab.

  6. #6
    Default Lab draws in the office
    Hello,
    I have two questions I need some help on.

    Our providers are billing the 99000 code, which I think is incorrect. 99000 code should only be billed if our providers are handling and transporting the specimen correct?

    Can our providers bill for 36415 for the blood draw in addition to the E/M service?

    Thanks for the help

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