Results 1 to 5 of 5

Venipunctures

  1. #1
    Location
    Barren River Area
    Posts
    28
    Default Venipunctures
    Medical Coding Books
    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.

    Thank you
    Sondra

  2. #2
    Location
    Columbia, MO
    Posts
    12,843
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Barren River Area
    Posts
    28
    Default
    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?

  4. #4
    Location
    Columbia, MO
    Posts
    12,843
    Default
    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.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Barren River Area
    Posts
    28
    Default
    Thank you so much for your help!

Similar Threads

  1. Billing for venipunctures
    By VeronicaAC1 in forum Auditing General Discussion
    Replies: 1
    Last Post: 07-18-2011, 09:48 AM
  2. Venipunctures and send out labs
    By sec5188 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 07-06-2011, 11:37 AM
  3. Venipunctures 36415 ??
    By Anduiza05 in forum Internal Medicine
    Replies: 1
    Last Post: 04-12-2008, 01:34 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.