Ob-Gyn Coding Alert

You can forget about Medicare reimbursing this code.

When your ob-gyn performs a Pap smear and sends it to an outside laboratory, you might be tempted to report 99000 — but you may be rolling the dice. Almost all will include or deny the line item (hence raising your AR and write-offs).

So here are some tips for reporting this code.

Capture Specimen Prep With 99000

You can report 99000 (Handling and/or conveyance of specimen for transfer from the 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, AAPC Fellow, AHIMA-approved ICD-10 CM/PCS trainer, and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida.

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).”

History Lesson: Realize CPT^® Changed Its View

If you scream, “But, wait! I’ve been told I can only use the code for incurring a cost,” be aware CPT^® promulgated this view years ago.

The AMA back in CPT^® Assistant Feb. 1999 noted, 99000 “is intended to be reported when the physician incurs costs to handle and/or transport a specimen to the laboratory (e.g., via messenger service). If the specimen is picked up by laboratory staff at no additional cost to the physician, it would not be appropriate to report CPT^® code 99000.”

Don’t miss: In CPT^® Assistant October 1999, the AMA did a complete 180, retracting the above opinion and clarifying 99000’s use. While using 99000 for incurring a transport cost is certainly a correct statement, “many of our readers pointed out a second use of this code that is also correct, and reflects the most typical use. 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.”

Example: For a finger stick in the office, a physician should report 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]). “In addition, code 99000 should be reported when the physician’s office centrifuges the specimen, separates the serum and labels, and packages the specimens for transport to the laboratory,” according to CPT^®’s clarification comment.

Do Not Report 99000 to Medicare Carrier

Medicare considers 99000 a bundled service and makes no separate payment for it. Some commercial payers may pay for the service.

Give a Point for Lab Ordering

For Pap smear collections, the ob-gyn can consider the work involved in collecting the specimens when selecting the office visit’s type of medical decision making, but the collection itself is included in the E/M service.

Using CMS standard auditing sheet, the physician would receive one point under “Amount and/or Complexity of Data Reviewed” for ordering the clinical lab tests. He receives only 1 point, no matter how many labs he orders.

The point could in turn affect the type of medical decision making, which could potentially increase the level of E/M service (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient …) selected.