Pediatric Coding Alert

Question: Payers are not reimbursing 99000 for cultures. Am I using this code correctly?


Idaho Subscriber

Answer: You may charge 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) when your staff prepare lab work for transporting. "If the specimen (that is, blood, urine, stool, cerebrospinal fluid) is collected in the office and sent to an outside laboratory, the office visit plus any venipuncture or spinal tap and a handling fee should be billed," says Coding for Pediatrics.

Be careful: When you transport specimens out of your office to your own centralized lab, handling fees do not apply.

Problem: Some payers include the handling charge in the day's E/M service, such as 99213 (Office or other outpatient visit for the evaluation and management of an
established patient...). Insurers base this payment policy on Medicare. Medicare's fee schedule denotes 99000 as a "B" status code, meaning the covered service is always bundled into payment for other services - like an office visit. To reduce specimen handling charges, consider sending patients to a lab for blood work.

You will, however, still have to take cultures, such as urine specimens and throat swabs, in-house. Unless you have the equipment to do the tests in your office, you will have to incur the transport costs - or bill the patients for them if the payer considers this a noncovered service.