# Need helpm with billing 99205 and 36415



## mauadajar (Jul 9, 2015)

Hello. If I am billing 99205 for a new Pt and the medical assistant did a blood draw for  Cancer Screening, do I bill 99205,25 and 36415? I am getting mixed information about this. Some people said to not use a modifier, some people said use 25. I also saw one post that they use 90. A claim got sent back to our EMR stating modifier mismatch.We billed 99205,25 and 36415.


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## lgardner (Jul 9, 2015)

no modifier is required for this.


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## mauadajar (Jul 9, 2015)

Thank you for your response. I will redrop the claim


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## mauadajar (Jul 23, 2015)

So, I dropped the claim that I mentioned about last time. It was for Aetna Better Health. It came back and it said the same thing, This procedure code is inconsistant with the modifier used or a required modifier is needed .

I billed 99205 and 36415 without any modifier. I got the same denial. Does any of you know what modifier I should be using?

Thanks


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## mitchellde (Jul 23, 2015)

They are more than likely wanting to bundle the 36415 into the E&M.  However what dx codes did you use and how did you link them.


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## mauadajar (Jul 23, 2015)

mitchellde said:


> they are more than likely wanting to bundle the 36415 into the e&m.  However what dx codes did you use and how did you link them.




99214- 621.2, 626.2, 626.8, 625.9

36415- 61172, v1641, v163


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## AKALLOO (Jul 24, 2015)

*99205 and 36415*

There is no modifier needed when billing an office visit with venipunture.  I review E & M services and bill for the venipuncture and never was there a denial.  Just make sure you are linking the correct diagnosis.


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## philipwells (Jul 29, 2015)

In my experience with billing 36415 to different commercial insurers, some payers require modifier 90 on the 36415 and others require modifier 33 on the 36415.

Never bill a 25 modifier on the office visit with most all labs, IE your 80000 series codes.


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## Edithcha (Aug 24, 2015)

So which modifier should be used for a complex patient who needs lab work but not necessarily as preventive (i.e. AIDS patient) ? 99205-25, 36415?


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## jademound (Sep 9, 2015)

*No Modifier*

I bill these 2 charges to commercial payers on a daily basis. We do not use a modifier on the claim. Just bill the 99205 & 36415. Do you also have lab charges on the claim, or is it just the draw fee? Our lab charges go on the claim with the draw fee.


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