Pediatric Coding Alert

Question: When we bill 36415 x 7 with V77.1 for a diabetes screening that an outside lab performs, insurance companies only pay 36415. We also use 99211 for the office visit. No insurers reimburse the handling fee, so we don't report 99000. Are we coding these cases correctly? 

Colorado Subscriber

Answer: Most payers allow only one collection fee per patient encounter, regardless of the number of specimens drawn. When a single test, such as glucose tolerance (82951-82952), requires a series of specimens, you should treat the draws as a single encounter. So, you should bill 36415 (Collection of venous blood by venipuncture) linked to V77.1 (Special screening for endocrine, nutritional, metabolic and immunity disorders; diabetes mellitus).

Many insurers also consider 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) a collection fee. So, they pay for either 36415 or 99000.

Be careful reporting 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...). If the child comes in only to have a blood draw, you should charge for the collection, not the office visit.

But you may report 99211 if the nurse or other staff member takes a history of the patient or documents a chief complaint. Some companies, however, may bundle the E/M service with the venipuncture code.