Primary Care Coding Alert

Question: One of our physicians made three attempts (arterial, femoral and brachial) to draw blood from a Medicaid-covered newborn but was unsuccessful. How should we code to show that the attempt was made, but a specimen was not obtained?

New York Subscriber

Answer: Because Medicaid is regulated at the state level, it is difficult to give a definitive answer. In many states you are not allowed to bill for a lab service that was not completed. The reason behind this is that the code pays for the processing and analysis of the specimen not just the time and effort that was expended to obtain the sample.

On the other hand, you may receive payment from some insurers for various office tests vision or audiometric, for example that arent completed. An example a 4-year-old child being seen for her wellness exam (99392, periodic preventive medicine, established patient; early childhood [age 1 through 4 years]) who doesnt cooperate throughout the visit. If the physician or nurse tried to perform a Stenger evaluation (92565, Stenger test, pure tone), but was unsuccessful, the practice is allowed to bill the procedure.