Wiki modifier 59 for 36415

[sukheshini]

Hi Everyone,
Need to know if modifier 59 must be appended to CPT 36415 (blood draw) along with an office visit. Does it affect the reimbursement of 36415.
My pediatrician says that appending mod 59 to 36415 for medicaid claims would get better reimbursed.
Please help!

Sukheshini

 

[mitchellde]

no it does not affect the reimbursement amount. If you have an ov and the venipuncture and that is all that is on the claim then you may append a 25 to the ov (assuming you are NOT charging a 99211). Some carriers will bundle the 36415 with the ov anyway.