Wiki Venipuncture - new to FP billing

[kadensmom]

Hi all,

I need help with venipuncture. I am not having any difficulties getting this paid with anyone but Medicare. I never get a denial that says "non-covered", so I do not understand what I am missing.

Scenario 1 - We send our labs out for processing, patient sees doctor and lab is drawn same day. 9921x/25 with 36415. Medicare always separates the 36415 and denies immediately.

Scenario 2 - Scheduled lab draw with nurse. Patient comes in for lab draw and typical vitals prior to draw. I bill 36415 and it is denied.

Is something required on the claim that I am missing? Such as referring/ordering, date of last visit, etc? I have searched Trailblazer's website and I am not coming up with anything to support how to bill these claims, or whether or not this CPT is covered for outside labs.

Help!

Thanks,

Kara Hawes, CPC

 

[mitchellde]

There has to be a denial code that matches to a reason for the denial, typically Medicare will roll the venipuncture into the office visit or into the lab code. But usually will pay when it is listed by itself. Also what dx code are you using vs what is the reason for the blood collection.

 

[kbarron]

We make sure that a referring MD is on the claim. We were having the same problem and this seemed to solve it.

 

[kadensmom]

Thanks ladies. I have reviewed my diagnoses and they appear to be appropriate for why the lab was drawn. I am not getting a denial that states the diagnosis(es) are non-covered or are not consistent for the procedure performed. Maybe I am missing something like Karen suggested. I will go back over my EOBs.

Is there a modifier to indicate that the draw will be sent to an outside lab? I found some brief info on modifier 90, but it looks like that doesn't apply to us since the lab is outsourced.

Kara Hawes, CPC