Wiki CPT 36415 Issue

[stilesmed]

Hello everyone!

I work for a doctor whose specialty is Radiation Oncology. We bill a 36415-59(Venipunture) with an E&M code.

For some reason, Medicare and the commercial insurances, deny the code, stating it's incidental to the e&m.

How can I get the 36415 paid?

TIA

 

[csperoni]

Some commercial carriers will bundle the blood draw same day as E&M, regardless of how many modifiers you put on there. I did think Medicare would pay separately as there is no NCCI edit, but I haven't worked in an office doing venis in a long while. If you do a forum search for this, you will see a lot of the same issues/advice.
Keep in mind, if it was an NCCI edit, it would not be -59 on the veni, but rather -25 on the E&M. Some payors may pay this way, but you would have to confirm with your carriers.

 

[stilesmed]

Some commercial carriers will bundle the blood draw same day as E&M, regardless of how many modifiers you put on there. I did think Medicare would pay separately as there is no NCCI edit, but I haven't worked in an office doing venis in a long while. If you do a forum search for this, you will see a lot of the same issues/advice.
Keep in mind, if it was an NCCI edit, it would not be -59 on the veni, but rather -25 on the E&M. Some payors may pay this way, but you would have to confirm with your carriers.

Thank you for your reply!

 

[sls314]

Hello everyone!

I work for a doctor whose specialty is Radiation Oncology. We bill a 36415-59(Venipunture) with an E&M code.

For some reason, Medicare and the commercial insurances, deny the code, stating it's incidental to the e&m.

How can I get the 36415 paid?

TIA

I'm just curious, because I code radiation oncology for physicians. What is the reason for the venipuncture charge?

In my experience, that's unusual for a radiation oncologist. If labs need to be run, typically you'd want the results back before the consult or the post treatment follow-up visit.

(You probably know this already, but remember that you can't bill an E/M charge within 90 days of the last treatment day. E/M services are bundled with the 77427 treatment management codes. Rad Onc has very minimal E/M compared to other specialties.)

If you're drawing the blood during the visit, are they coming back for another E/M visit to get results?

I run a Facebook group for Radiation Oncology Coders & Billers. You're welcome to join if you want a place to ask questions about rad onc coding - we're up over 300 members now, and there are lots of helpful people in the group. https://www.facebook.com/groups/radiationoncologycoders/