Forum - Questions & Answers

Oct 19th, 2011 - vsmichael 20 

Abn

Can an ABN be issued to a Medicare beneficiary for CPT® 36416, capillary stick? Or is it simply not recognized by Medicare and the beneficiary cannot be billed? Please Advise. Thanks so much!!

Oct 19th, 2011 -

re: ABN

It is an interesting question but that would take some nerve to charge for that.

Oct 20th, 2011 - vsmichael 20 

re: ABN

Hmmm....guess no one has the nerve to address it, either, because I cannot find anything out there on how to handle it. Why then, is there a CPT® code for it? And some payers pay for it. Thank you for your response, though.

Oct 20th, 2011 - ruthie72 13 

re: ABN

HI i just did some research and INRATIO on how to reimburse for PT/INR, stated

Medicare reimburses for venous samples, but not finger sticks. If the patient is having the in-house PT test and is covered by private insurance, you may be able to bill CPT® code 36416(collection of capillary blood specimen, eg, finger stick, heel, or ear stick)for the finger stick.
Check insurance co for more info..
Code 85610
QW modifier for CLIA

Oct 20th, 2011 - vsmichael 20 

re: ABN

Yes, I knew that about billing for the PT/INR and the finger sticks, etc. I knew Medicare reimbursed for a venous collection. My question that I cannot find any answer on is, "Can an ABN be issued to a Medicare beneficiary for a capillary stick?" For instance on a HgbA1c claim, it would be 83036 QW and 36416. Can an ABN be issued to the MCR beneficiary for the charge for the capillary stick? Or does CMS regard the capillary stick as an inherent aspect of CPT® code 83036? That is what I cannot find any guidance on.
Most commercial insurance, non-Medicare Advantage plans reimburse for CPT® code 36416. Anyway, thanks to all for responding. I greatly appreciate your time!

Oct 20th, 2011 -

re: ABN

Well, technically an ABN is only for services that Medicare covers in certain circumstances and not others, like a Lipid panel that a patient wants every month or a PSA every 6 months as a screening. You do not have to get an ABN signed for things Medicare never pays for, like liposuction, face lifts, buttock implants. So Medicare never pays for a capillary stick therefore you are free to charge the patient for it without an ABN. As you said there is a CPT® so it is a chargable service. But I think you would be asking for trouble...some crabby old lady is going to call CMS and you'll have an auditor looking at every single charge. And if your doc wants to charge for this, I have a hunch that the E&M coding tends to the overcoding side of things and that's big bucks in an audit. But I hope I am wrong!

Oct 24th, 2011 - vsmichael 20 

re: ABN

Thank you, again! You answered my question. :-)



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