Primary Care Coding Alert

Question: Some of our Medicare patients want to drop by and have blood drawn so that when they come for their next visit we'll have the test results. We code 36415 to track the lab work, but the payers deny our claims. Does Medicare view this as part of either the prior visit, or the next when the doctor discusses lab results?

Florida Subscriber

Answer: No, Medicare should pay for the service if the patient hasn't had a recent blood draw elsewhere for the same diagnosis. Continue to report 36415 (Collection of venous blood by venipuncture). Include a supporting diagnosis that relates to the lab test for which the blood is being drawn, such as hypertension (401-405, Hypertensive disease) or high cholesterol (such as 272.0, Disorders of lipoid metabolism; pure hypercholesterolemia). Include the patient's usual physician as the referring doctor.