Forum - Questions & Answers

Jun 19th, 2013 - BMR2013   6 

36415 and Lab CPT® codes

We are receiving denial for CPT® 36415 stating that it is incidental to the lab work. I want to know where in the coding guidelines it states that these procedures are incidental.
I checked the CCI edits and they are not bundled.

Can anyone help me regarding this ?

Jun 20th, 2013 - rphelps 615  1 

re: 36415 and Lab CPT® codes

Is it a particular insurance denying. I bill this everyday with labs and get paid like 3.00.

Jun 20th, 2013 - Billingexperts 7 

re: 36415 and Lab CPT® codes

Are you using a 25 modifier on the office visit??

Jun 20th, 2013 - BMR2013   6 

re: 36415 and Lab CPT® codes

Lets say for an Example : We have billed the claim with 36415,80053,99215,90471,90732.

All other codes were paid by the insurance other then the CPT® 36415 (Denied-Bundled with 80053).

Modifier 59 is not override the denial or not suitable for CPT® 36415.

please be kind enough to provide me a solution or please tell me a guideline, where can i get the details about this denial, So can write off the code.




Jun 20th, 2013 -

re: 36415 and Lab CPT® codes

I put these codes into the encoder and it gave me the following error message:

"You have coded 90471 in additiom to 99215 The Medicare NCC edits consider this seperate reporting of codes that are componets of the comprehensive procedure if billed for services provided to the same beneficiary on the same day. These codes will be rebundled by your medicare payor and will be based on code 90471 only. * if these codes represent a deiifernt session, surgery site, lesion, or injury, then use of an appropriate modifier on the excluded code will differentiate the services provided and will notify the payor to bypass this edit."
References:
Medicare outpatient code editor

Jun 20th, 2013 - Billingexperts 7 

re: 36415 and Lab CPT® codes

The 25 should be on the office visit, which sounds like it was because you got paid for the ov.... so that is good. The 36415 lab draw fee may need to be specifically pointing to a specific dx. They shouldn't bundle it. I get paid for 36415 all day , every day no matter what else I bill with but it could be that you need to point 36415 to some dx and the 80053 to another so it can be distinctive.

Jun 21st, 2013 - BMR2013   6 

re: 36415 and Lab CPT® codes

Thanks..

Now i got a clear picture of this. So, we can't bill the CPT® 36415 (Venipuncture) with Lab codes (Ex - 80050, 80053, 85025, Ext) under the same DX code.



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