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Blood cx and 36415

  1. Default Blood cx and 36415
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    We charge for the venipunctures and not the blood cultures, but how can we charge for two venipunctures without one being denied duplicate? We drew aerobic and anaerobic-which they have to be done from seperate areas. Is it appropriate to use a modifier and which is the best one? Or can we not charge 2 venipunctures?

    Thanks

  2. Default
    This may be a unique situation where modifier 59 would apply. Separate service, separate site, separate reason. I would contact the carrier and find out if that would be appropriate with them, or if they would prefer another modifier or method of conveying what was done and why.

    Kris

  3. #3
    Default
    Most payers still only pay one venipuncture on a DOS.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. Default
    Quote Originally Posted by bpct6501 View Post
    Most payers still only pay one venipuncture on a DOS.
    Perhaps that may be true for some carriers. Perhaps not for all carriers, or for all instances of medical necessity.

    Even if that were positively factual, there is no reason why a practice cannot bill for what was done to have an appropriate accounts receivables to reflect that two services were done with one paid and one not allowed.

    Billing for all services performed allows the practice to capture the true work being done, as well as correct financials of gains and losses. This is important in the scope of supporting the continued need, or additional need, for employees, as well as black and red in finance.

  5. Default
    Thanks for the help. To me it does seem appropriate to use the modifier for this but I wasn't sure if there was a rule.

  6. #6
    Default
    I agree, Kris.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  7. #7
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    Default 76 modifier
    76 Modifier - Repeat procedure

    When you are coding the exact same CPT code within a global period (or on the same date of service for those services with -0- global days). The -76 modifier lets the carrier know that this was not an error or duplicate charge, but that, in fact, the procedure/service was performed twice.

    F Tessa Bartels, CPC, CPC-E/M

  8. Default
    Quote Originally Posted by FTessaBartels View Post
    76 Modifier - Repeat procedure

    When you are coding the exact same CPT code within a global period (or on the same date of service for those services with -0- global days). The -76 modifier lets the carrier know that this was not an error or duplicate charge, but that, in fact, the procedure/service was performed twice.

    F Tessa Bartels, CPC, CPC-E/M

    Modifier 76 does appear appropriate, but it is not actually a repeat procedure. The second 36415 is being done for a completely different reason than the first. That's where modifier 59 may be the more appropriate modifier. The only reason I am posting this thought process is that this is very similar to a scenario I encountered recently and modifier 59 ended up being the accurate one to use.

    It is not like performing an EKG and then performing another one a few hours later to see if the abnormality is the same or changes. With that in mind, perhaps consider the perspective that the second blood draw is not a repeat service because we are not repeating it for the same test to be done.

    Perhaps it won't even matter what modifier is used. Whether 76, or 59, I would still recommend contacting the carrier and verifying if they have a preference.

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