# Bundled Services



## heatherwinters (Mar 20, 2009)

Our clinic has found that Medicare is bundling 99000 and 36415 together, so for Medicare only patients I will report only 36415, however, if a patient is dual eligable, how would you handle that?  If you have found that one of the two insurances pays for the service do you bill it as unbundled to both, or do you follow the primary insurances rules when coding the encounter?


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## dmaec (Mar 20, 2009)

so, you charge the 99000 because?.... your clinic physically brings the specimen from the clinic facility to another/different facility where the lab is?


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## ARCPC9491 (Mar 20, 2009)

right, 99000 shouldn't be charged unless you are physically taking the specimen to the lab to be processed, which in all my years have never seen a practice do. The lab typically has a courier to collect ... you should be charging only 36415


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## dmaec (Mar 20, 2009)

*nods* in agreement with ARCPC9491's comment.  I've never seen this code used either (or at least we've never used it). But our lab is "here". that's why I was wondering "why" do you charge for it, what justifies it's use?  
I know before I worked at a different facility, they "DID" have the lab at another building, I believe back then (few years ago, before my time).. they did use a conveyance code.

so I'm curious as to why you use it.


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## heatherwinters (Mar 20, 2009)

*36415*

Please read this article
http://codingnews.inhealthcare.com/...imen-handling-more-than-just-a-messenger-fee/

The position that a physician can only charge 99000 if he incurs costs to handle and/or transport a specimen to the laboratory was retracted , see CPT Assistant October 1999

Code 99000 is also intended to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory. Typical work involved in this preparation may include: 
• Centrifuging a specimen
 • Separating serum
 • Labeling tubes
 • Packing the specimens for transport
 • Filling out lab forms and
 • Supplying necessary insurance information and other documentation.”

That is why we report it, and some commercial payers cover it in addition to the 36415.  It is not just for actual transport to the lab.


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## ARCPC9491 (Mar 20, 2009)

There's a lot of confusion with this code. I always hear "don't forget to code the specimen handling fee" my response is BUT...the second part to the code is "taking it to the lab"... you may be "handling" the specimen but in order to "draw" the specimen you have to "handle" it right?  I think the general consensus amongst practices is it's "just for specimen handling" and they don't realize it's more than that.


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## heatherwinters (Mar 20, 2009)

*Specimen Handling*

According to the above article:


You can report 99000 (_Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory_) “for the preparation of a specimen for lab transport, even when there is no cost incurred with the labs charging for pick up and transport of the specimen for processing,” assures Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, manager at Pershing Yoakley & Associates, P.C. in Clearwater, Fla.
 *Specifics:* “The work involved by the staff/physician in preparing the specimen (centrifuge, labeling, packaging, completing lab slip, etc.) meets the requirements for appropriate reporting of this code (handling).”


In our office, the nurse draws the lab, uses the centrifuge, labels it, boxes the specimen in protective container, packages, completes a lab slip and supplies all of the insurance information for the lab.  I believe that meets all of the requirements for the code use  as indicated in the above article.


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## dmaec (Mar 20, 2009)

I'm still in agreement with ARCPC9491 on this issue.  
I see what you posted, however I still believe they mean "handling" for actual transport/conveyance", ...

"Specifics: “The work involved by the staff/physician in preparing the specimen (centrifuge, labeling, packaging, completing lab slip, etc.) meets the requirements for appropriate reporting of this code (handling).”
to me this means that the staff, physician IS doing the actual preparing of the specimen (address, name, packaging, etc) so that it can be transported to a lab (safely and appropriately) it doesn't mean, the doc writes the order, with my name on it, and the nurse folds it neatly, sticks the little name labels on the paper and pee cup and hands it to me, then points me to the lab down the hall for lab work.. THAT isn't "handling".  at least not to me. 

we don't use it.  How is payment on it anyway? (from the other insurances)


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## Lisa Bledsoe (Mar 20, 2009)

The actual description in CPT states "for transfer".  I have seen this code used but rarely (if ever) paid for.  Medicare definately will not pay for it.  CDR states it is "adjunct to basic services rendered" which to me means it's bundled with 36415 or even possibly and E/M.  I personally would not bother with this code.


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## heatherwinters (Mar 20, 2009)

*Lab*

In our office, the patient comes in, she draws the lab according to the physician's order, she spins the specimen, labels the tube, packages it in protective packaging, inserts the order signed by the doctor with the specimen, puts it in a protective bag biohazard bag and the lab courier picks it up for transport for actual testing.  The payment on the code is about 12.00, so it is not a huge monetary amount, but it helps to offset the cost to the practice for the work of the nurse above and beyond only drawing the lab specimen.


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## ARCPC9491 (Mar 20, 2009)

Even though I do not agree with the use of this code, I do have clients who continually use it... Medicare certainly doesn't pay for it... the private insurers do sometimes... I think the charge is about 20 bucks and they pay about $5-$10


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## heatherwinters (Mar 20, 2009)

*Coding and Billing for Pediatrics*

In a coding audio seminar "Coding and Billing for Pediatrics", given by the AAPC last August, the presenter, Lisa Jensen, MHBL, CPC, recommended it's use.  She indicated it could be used for paps and blood samples.  

See also 
http://www.gastro.org/user-assets/Publications/gipmn/01/vol1no6-2001.html

According to this article from GI Practice Management News

Venipuncture/Specimen Handling— Though     some insurance companies will attempt to bundle venipuncture and the     collection and processing of specimens into the E/M service, many others     will pay separately for these services. If you do not bill for     laboratory services and you send blood and other specimens to an outside     lab for processing and analysis, you should bill Medicare for the     venipuncture using HCPCS G0001 and CPT 36415 for all commercial     insurers. For the collection and handling of other non-blood fluids or     tissue samples, use CPT 99000.

I know it comes out to a lot of revenue posted on our system, how much we actually are reimbursed and how much we have to write off is the next issue I guess.  However, as coders, if a code exists for a procedure, arent we supposed to code it, regardless of reimbursement if it is justified by the documentation, unless it is bundled?


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## Anna Weaver (Mar 20, 2009)

*99000*

This is funny! We were just having this very discussion this morning in the office. We recommended last year that this not be charged because the lab is owned by the hospital and our physicians are hospital employees. All expenses are incurred by the lab for supplies, they have a courier, etc. But, the article that came out in family practice coding alert Vol. 11 No. 5 2009 says it should be charged. They cite the CPT assistant Feb 1999 also as in a previous post. So, we discussed and decided to re-visit this issue. But, I'm still not convinced on this.


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