# Medicare denial for 83036



## dragonclawz70 (Jul 9, 2021)

Does anybody have luck getting 83036 (hemoglobin A1C) paid for on the same date of service that a CMP or BMP (80053 or 80048) is checked?  A lot of these patients have diabetes so it doesn't seem unreasonable to check their hgb A1C. The denials all are either CO16 (claim/service lacks information which is needed for adjudication) or CO50 (noncovered services not deemed medical necessity by payer).   We've never billed that test using the QW modifier so I was wondering if that's the key.  Thanks for any advice!


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## suki_26 (Jul 13, 2021)

We use the QW mod on the 83036.  we bill a full blood panel regularly which will include the 83036 and the 80053 and haven't  had any problems.

But the commercial Medicare or Advantage plans.. that's a different story. The don't always follow MCR guidelines.


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## erjones147 (Jul 13, 2021)

We generally get CO50 errors on our A1c's for two reasons - done too often or unsupported dx (like when the providers insist on getting A1c's for hypertension)


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## dragonclawz70 (Jul 16, 2021)

erjones147 said:


> We generally get CO50 errors on our A1c's for two reasons - done too often or unsupported dx (like when the providers insist on getting A1c's for hypertension)


Sometimes I have to roll my eyes when I see the bloodwork that the provider orders when I'm entering the charges, I think they assume because they order it that it gets paid for every time!  We have to write off quite a few of the CO50 denials because there's no "valid" diagnosis for doing the bloodwork!  Don't even get me started on thyroid and vitamin D testing


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## dragonclawz70 (Jul 16, 2021)

suki_26 said:


> We use the QW mod on the 83036.  we bill a full blood panel regularly which will include the 83036 and the 80053 and haven't  had any problems.
> 
> But the commercial Medicare or Advantage plans.. that's a different story. The don't always follow MCR guidelines.


I've been researching the QW modifier, I didn't know about that until recently so I'm going to test it out.  Do you automatically add a QW to the 83036 every time they order a CMP or BMP? Or only if it gets denied?


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## suki_26 (Jul 26, 2021)

Its in our system to automatically add the QW once the 83036 is entered.  It makes it a lot easier for things we know will always need a mod.


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## dragonclawz70 (Jul 28, 2021)

Thank you Suki!  I just found out something interesting yesterday, I called VT Blue because of a denial on the 83036 to see if they could tell me why, this lady has diabetes and hadn't had an A1C in almost a year and we have written off so many of them lately it's getting ridiculous. They told me that they had a change as of 01/01/21, every 83036 has to have a CPT II code which is based on the result, so now I have something else I have to research because honestly I've never heard of CPT II codes or had to use them, so I don't know how to add them. That's going to be A LOT of extra work honestly, having to look at the result of the lab test and add that specific code every time??  Wow!!


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## suki_26 (Jul 28, 2021)

Are they talking about code groups on the LCD?
 Im confused, are they talking about the reporting codes? that doesn't make sense to use a reporting code with a blood code. Especially to BCBS. We use reporting codes to Medicare but never to a commercial insurance.  The only other thing I can think of is ..for example if we bill a Procrit injection, we have to manually go in and add the Hemoglobin values.  Hmmm


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## dragonclawz70 (Jul 28, 2021)

suki_26 said:


> Are they talking about code groups on the LCD?
> Im confused, are they talking about the reporting codes? that doesn't make sense to use a reporting code with a blood code. Especially to BCBS. We use reporting codes to Medicare but never to a commercial insurance.  The only other thing I can think of is ..for example if we bill a Procrit injection, we have to manually go in and add the Hemoglobin values.  Hmmm


VT Blue is a Medicare advantage plan, this is what the customer service person there directed me to on their website when I called:

Blood Sugar Monitoring Billing Guidelines Beginning January 1, 2021, when billing the HgbA1c lab test CPT code 83036 and 83037, providers must also bill the associated CPT Category II code which represents the result of the test in the form of a range of values. VBA will not reimburse physician offices for lab services performed for VBA Medicare Advantage members without submission of the appropriate CPT II code. The following table lists the lab test, the billable CPT Category I code, the CPT Category II codes and the associated value range. Test CPT Code CPT II Code Associated Value Range HbA1c screening 83036, 83037 3044F Less than 7.0% 3051F Greater than or equal to 7.0% and less than 8.0% 3052F Greater than or equal to 8.0% and less than or equal to 9.0% 3046F Greater than 9.0%

I know this is probably a dumb question but where would I put the code (for example 3044F) when I'm entering the charges?  Thanks for any advice!


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## SharonCollachi (Jul 28, 2021)

dragonclawz70 said:


> VT Blue is a Medicare advantage plan, this is what the customer service person there directed me to on their website when I called:
> 
> Blood Sugar Monitoring Billing Guidelines Beginning January 1, 2021, when billing the HgbA1c lab test CPT code 83036 and 83037, providers must also bill the associated CPT Category II code which represents the result of the test in the form of a range of values. VBA will not reimburse physician offices for lab services performed for VBA Medicare Advantage members without submission of the appropriate CPT II code. The following table lists the lab test, the billable CPT Category I code, the CPT Category II codes and the associated value range. Test CPT Code CPT II Code Associated Value Range HbA1c screening 83036, 83037 3044F Less than 7.0% 3051F Greater than or equal to 7.0% and less than 8.0% 3052F Greater than or equal to 8.0% and less than or equal to 9.0% 3046F Greater than 9.0%
> 
> I know this is probably a dumb question but where would I put the code (for example 3044F) when I'm entering the charges?  Thanks for any advice!


Put it on a line by itself, with a zero dollar charge, or if your system won't let you do that, put a one cent charge on it.

like this:

83036.... $100.... dx1, dx2, dx3
3044F....  $0....... dx1, dx2, dx3


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## dragonclawz70 (Jul 28, 2021)

SharonCollachi said:


> Put it on a line by itself, with a zero dollar charge, or if your system won't let you do that, put a one cent charge on it.
> 
> like this:
> 
> ...


Thank you!!


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## suki_26 (Jul 29, 2021)

Holly cow that's a LOT I haven't come across this yet.


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## Countrycoder19 (Apr 22, 2022)

dragonclawz70 said:


> Sometimes I have to roll my eyes when I see the bloodwork that the provider orders when I'm entering the charges, I think they assume because they order it that it gets paid for every time!  We have to write off quite a few of the CO50 denials because there's no "valid" diagnosis for doing the bloodwork!  Don't even get me started on thyroid and vitamin D testing


Thyroid and Vitamin D testing is why I'm reading all threads on labs lol I'm beating my head against a wall.


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