Pediatric Coding Alert

Question: I was under the impression the handling fee was only for labs that our office sends out, not for labs that we perform in-house. A patient comes in and we do the urine dip in-house and send the specimen to a lab for a culture. Can we charge a handling fee for the culture? Suppose a patient has an in-house strep and we send the specimen out for culture. Does 99000 apply to urine and blood specimens only, or can I use the code for throat cultures as well?

Kentucky Subscriber

Answer: You are correct in your understanding of 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory): Reserve the code for packaging, handling, and conveyance of a specimen that your office sends to an outside lab. You can use 99000 to "reflect the work involved in the preparation of a specimen prior to sending it to the laboratory," states CPT Assistant October 1999. "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." This has to be to an outside laboratory, not a general lab for a group of offices.

Check out this example from CPT Assistant: A physician performs a venipuncture in the office to obtain a blood specimen. You should report 36415 (Collection of venous blood by venipuncture). "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."

For the solution to your second question regarding what kind of specimens fall under 99000, look at the code's descriptor. It does not specify a certain type of specimen or category of specimen, points out the AMA. "Therefore, it applies to any specimen prepared for transport to a lab (blood, urine, biopsies, pap smears, tissue, etc.)" Here's how to code your scenarios:

Urinalysis: For the urine dip in-house, do not report 99000. You instead would use the urinalysis code -- for instance, 81000 (Urinalysis, by dip stick ...non-automated, with microscopy). For the specimen transport prep to send the urine out for culture, you could use 99000.

Throat culture: Code the in-office rapid strep, such as 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A). For preparing the throat culture for transport to the outside lab, you could report 99000.

-- Information and/or answers to You Be the Coder and Reader Questions provided by Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, manager at Pershing Yoakley & Associates, P.C. in Clearwater, Fla; and Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.