Tag Archives: 36415
Posted on 05. May, 2010 by Editor.
Question: Our vascular office performs blooddraws and analysis for a local hospital. Can we bill for a lab draw in an office setting, and if so, what codes should we use?
Answer: If you’re sending your patients to an outside lab for both the blood draw and testing, you cannot report any blood draw codes. If your office collects the blood, you have two coding options, depending on the next step.
Posted on 01. Nov, 2009 by atif.adnan.
In last week’s Coder’s Cranium, we started a checklist of 3 things you should know to correctly bill for a nonphysician practitioner’s services — and stay compliant. This week, we complete the checklist with advice for items 4, 5 & 6.
4. Have You Distinguished Auxiliary Personnel From NPP Services?
NPPs can supervise auxiliary personnel (registered nurses [RNs], licensed practical nurses [LPNs] and technicians) for incident-to services just as a physician would supervise the NPP.
The catch: You must bill the auxiliary personnels services under the NPPs number, and you may only receive 85 percent reimbursement. For example, the physician is out of the suite doing rounds in a hospital while a PA sees patients in the suite under her provider number. A patient comes in for a blood draw, which a nurse on staff performs. The nurse should bill 36415 (Collection of venous blood by venipuncture) under the supervising PA’s provider number.
Watch out: State license laws determine the scope of practice under which NPPs can operate. So be sure to check your states licensure policy on incident to as well as other services (such as their ability to prescribe) because the scope of practice may not align with Medicare. The stricter set of laws takes precedence.
Posted on 08. Oct, 2009 by .
Question: An established type II diabetic patient comes in for a blood draw for glycohemoglobin. After the draw, the patient reports a sore left shoulder; she says it is a 4 on the 10 pain scale, with pain diminishing in the past few days. The nonphysician practitioner (NPP) takes a history related to shoulder pain, performs an examination of the shoulder, and diagnoses a mild coracohumeral sprain. The NPP recommends ibuprofen and rest for the shoulder, and sends the patient home. Should I roll the blood draw into the overall E/M level?
Answer: You should report separate codes for the NPP’s shoulder exam and blood draw, with corresponding diagnosis codes to separate the services. On the claim, report the following:
• 36415* (Collection of venous blood by venipuncture) for the draw
• 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) appended to 36415 to represent the reason for the draw
Posted on 05. Mar, 2009 by .
With incident-to services on insurers’ radar, you’ve got to ensure documentation supports your 99211 claims to avoid facing huge paybacks.
Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of the physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) pays approximately $18.75 (0.52 relative value units on the 2009 Medicare Physician Fee Schedule) per encounter.
To see if your 99211 charges will stand up on review, take this quiz.