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Thread: cpt 99000 - ex..99000-for blood and 99000-for pap

  1. #1

    Default cpt 99000 - ex..99000-for blood and 99000-for pap

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    Hi there..one of my practices wants to use this code twice in one day (ex..99000-for blood and 99000-for pap) I say we can't do this, it can only be charged one time. However can someone give me a set reason as to why so I can explain it to the manager of the practice. Thank you.
    PS..I am aware of the payment issues of this code.

  2. #2

    Default

    If you are just collecting the specimen and not actually transporting to the lab, you cannot charge for 99000.

    Here is the lay description: This code is adjunct to basic services rendered. The physician reports this for the handling and/or conveyance of a specimen from the physician's office to a laboratory.

    There's a misconception that you can use this code for "specimen handling" only - but there's the second part for the handling/conveyance to the laboratory itself.

    But if you do transfer to the lab, by all means bill it. But, we use it one time only, no matter how many specimens are collected. It just seems right and logical. I don't really have an explanation, except for like you said about the payment issues, they bundle it anyway, so your write offs are just going to be higher if you are charging it multiple times.

  3. #3
    Join Date
    Apr 2007
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    12

    Default more info please

    Does anyone have any more info on this? I am a part of a large hosp/physician organization and we were told to bill 99000 for any specimen that goes to outside lab. We only bill it once per day per patient even if more than one specimen. Most ins. do not cover and charge gets adjusted off for those contract issues. Our patients who do not have ins. coverage must pay since they do not have a contract. They get charged for the lab test, venipuncture and spec. handling. Our outside lab provides supplies and picks up specimens. Our staff does "handle" the specimen and prepare it for transport but it just doesn't seem fair to charge extra just for that. If anyone has anything else on this, I'd really appreciate it.
    thanks
    jennifer, cpc

  4. #4

    Default

    Thank you for your help, we are sending it to the outside lab and I am just trying to find out if there is a "true" reason that I tell the manager to not charge for this twice. Have a good day.

  5. #5
    Join Date
    Apr 2007
    Location
    Wausau, WI
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    11

    Default Cpt 99000

    Question: If you bill 87045, 87427, 87046, 87328 with 99000. Doesn't there need to be a primary code listed with this code or not with 99000? I have used Encoder to do Compliance Edit and it tells me to remove the 99000 or add the primary code to use this code? Is that a correct statement or can code 99000 be billed alone with these labs?

    Thanks,
    Lisa

  6. #6

    Default 99000

    If you bill 99000 for a patient who gets blood drawn at our office but we use an outside lab but the tech is in our office, can I bill 99000 and place 81 in the place of service for (outside lab transport) will this get paid?

    Thanks, Sharon

  7. #7

    Default When billing the 99000 and 99001 how is distance calculated

    When billing the 99000 and 99001 how is distance calculated? Has anyone used this code and included distance? We are an independent clinical lab and all specimens are sent to us from the patient directly. It could be as close as our home state or as far away as 3000 miles. Any assistance on this would be great and thanks.

    E. Fullilove

  8. #8
    Join Date
    Apr 2007
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    2,367

    Default

    Quote Originally Posted by tsjangel View Post
    When billing the 99000 and 99001 how is distance calculated? Has anyone used this code and included distance? We are an independent clinical lab and all specimens are sent to us from the patient directly. It could be as close as our home state or as far away as 3000 miles. Any assistance on this would be great and thanks.

    E. Fullilove
    I believe these codes are for the entity doing the specimen collecting ,Not the lab receiving the specimen which is included in the 80000 series code.

    Also many payers, especially ones that follow medicare, wont pay at all. CPT has a status indicator of B which means always bundled.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  9. #9
    Join Date
    Apr 2007
    Location
    Brownsville, Texas
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    30

    Default

    Quote Originally Posted by cowgrl4ever View Post
    Hi there..one of my practices wants to use this code twice in one day (ex..99000-for blood and 99000-for pap) I say we can't do this, it can only be charged one time. However can someone give me a set reason as to why so I can explain it to the manager of the practice. Thank you.
    PS..I am aware of the payment issues of this code.
    If you are billing the 99000 for the pap for a medicaid patient, I think that would be incorrect. TMHP manual states that we are not supposed to charge for the pap, it's bundled in with the visit. It doesn't allow us for the collection either. Unless you are performing the lab in house, you cannot bill anything other than the office visit.(in regards to this example)
    Kristine Hernandez-CPC

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