Pediatric Coding Alert

Question: Our states Medicaid program does not reimburse a drawing fee in the office setting or recognize the handling code 99000 (handling and/or conveyance of specimen for transfer from the physicians office to a laboratory). Our office is performing a heal stick draw for an infant with elevated PKU. This specimen must be shipped to a lab overnight. Using only 99211, the reimbursement is far below the overnight shipping fee. How can we code this so we are not losing money?

Massachusetts Subscriber

Answer: Try 99001 (handling and/or conveyance of specimen for transfer from the patient in other than a physicians office to a laboratory [distance may be indicated]) with a letter explaining the extraordinary circumstances requiring overnight shipping, although this code is only for collecting the sample outside the office. Alternatively, you could ship the sample to the lab C.O.D. and let the lab worry about reimbursement. A final solution is to send the patient to the hospital to undergo the repeat phenylketonuria (PKU) and let the hospital worry about billing.