AMY - The scenario you described is the one that we are coding for. We are an in house lab and we billed with 99203 and 36415. We got a denial indicating it is bundled with one of those two but NCCI doesn't indicate that - as far as I know.For the 99000 code, the only way for this to pay is if the laboratory service is not performed in the provider's office and the independent laboratory is going to bill the insurance directly for the test.
Do you have a lab in your office that you are trying to bill both the specimen collection and the handling of the specimen?
Insurance companies will not reimburse 99000 unless the description above is the scenario that you are coding for.
Hope this helps!!!
clia is QW not GW typo I'm sure but making sure they knew.Why is the clinic billing for a lab test that they are not doing?
80307 is a positive/negative test. If the test is positive, then the individual components and levels are identified (G0481 or G0482).
If the clinic is just collecting urine, they are billing the wrong codes.
If the clinic is using a rapid cup, they need a CLIA waiver on their claim and they should be billing 80307-GW (we haven't done these for a few years, so double-check the codes).
It sounds like the lab is either collecting and billing the test code, which is incorrect, or they are doing a rapid cup and billing incorrectly.