I have a claim that was denied. Patientwas seen for sutures, came in within 10 days for a blood draw charged a 99211 and 36415. Medicare not paying the 99211 as within the Global Period..... How do I get this paid since it was to do with something other than the sutures?
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Wiki Global Period
- Thread starter nelstx2
- Start date
caronstein
New
Modifier 24
mitchellde
True Blue
no you cannot charge a 99211 for a blood draw even when not in a global. You charge the 36415 and that covers the nursing activities including taking vitals.
OCD_coder
True Blue
There isn't enough information given in the initial post to elminate the 99211 or support using the modifier 24.
Review the documentation and see if there is supporting information to support both services not inclusive of the sutures performed a few days prior.
Example: A patient was scheduled to have a blood draw for routine TSH labs for their hyperthyroidism, but has a complaint about feeling lightheaded/dizzy and the patient is on hypertensive medication. The nurse could do a quick BP check run it by the physician and then draw the blood. Then the CPT codes should link directly to the diagnosis specifically and modifier 24, and 25 should be appended to the 99211.
99211 - 24, 25 (401.9)
36415 (244.9)
Otherwise, I do agree with not billing the 99211 just for the nurse to perform vitals and pre-blood draw evaluation.
Review the documentation and see if there is supporting information to support both services not inclusive of the sutures performed a few days prior.
Example: A patient was scheduled to have a blood draw for routine TSH labs for their hyperthyroidism, but has a complaint about feeling lightheaded/dizzy and the patient is on hypertensive medication. The nurse could do a quick BP check run it by the physician and then draw the blood. Then the CPT codes should link directly to the diagnosis specifically and modifier 24, and 25 should be appended to the 99211.
99211 - 24, 25 (401.9)
36415 (244.9)
Otherwise, I do agree with not billing the 99211 just for the nurse to perform vitals and pre-blood draw evaluation.
Last edited:
mitchellde
True Blue
to respond to OCD:
Since the dizziness and light headedness is a new complaint the nurse could not be the one to evaluate this and consult with the provider and charge a 99211. To be incident to this has to be a follow up visit for something already prescribed in the providers plan of care. To charge for ancillary personnel to see the patient while the provider is on site is an incident to encounter. There cannot be a 99211 charged in this scenario at all since it is just for a blood draw. If the patient is there for any other reason the physician or NP must be the one to see and evaluate the patient.
Since the dizziness and light headedness is a new complaint the nurse could not be the one to evaluate this and consult with the provider and charge a 99211. To be incident to this has to be a follow up visit for something already prescribed in the providers plan of care. To charge for ancillary personnel to see the patient while the provider is on site is an incident to encounter. There cannot be a 99211 charged in this scenario at all since it is just for a blood draw. If the patient is there for any other reason the physician or NP must be the one to see and evaluate the patient.
