Resolved Lab services

[MistyR_46049]

I have a hospital out of California, (office location) and they are billing venipuncture, and the lab codes (80047-89398), I see an order, however there is no result, or documentation it was performed, do you have updated CPT guidelines for lab services, a lot of the times I see that it is sent to LabCorp. Can the results be a few days after the lab DOS on a follow-up office visit? Or must it all be the same DOS as the lab draw, with the lab draw result and documentation it was performed as I do not see the supportive documentation to report the 36415.

Thanks

 

[Alicia]

You almost always will get a delay in the diagnosis. Even if the labs are done in house it might not be ready for the visit. That is why the providers will ask for the labs to be drawn ahead of time.

There must be a reason for the lab order. You need a dx. It could be a sign and symptom or monitoring of a current condition such as Hyperlipidemia.

 

[MistyR_46049]

You almost always will get a delay in the diagnosis. Even if the labs are done in house it might not be ready for the visit. That is why the providers will ask for the labs to be drawn ahead of time.

There must be a reason for the lab order. You need a dx. It could be a sign and symptom or monitoring of a current condition such as Hyperlipidemia.

When billing for the facility and we draw the lab, and then send out the labs, then the facility only gets payment for the 36415 right? They cannot bill the lab cpts if they sent them out? If it is profee we use the 90 modifier on the lab cpts but since this is facility I just wanted to make sure that when they send the labs to like LapCord or quest then they cant charge for both. Im just trying to find the guidelines for that. Thanks Happy New year

 

[Alicia]

You are right they don't both get to be billed. Stick is one, Test is the other. The modifier is used for both to show that TC or 90. I can not find anything that states otherwise. Everything I am reading states you can do it but don't double dip.

Here is a link to a pdf explanation (payor). https://www.modahealth.com/pdfs/reimburse/RPM012.pdf

 

[MistyR_46049]

You are right they don't both get to be billed. Stick is one, Test is the other. The modifier is used for both to show that TC or 90. I can not find anything that states otherwise. Everything I am reading states you can do it but don't double dip.

Here is a link to a pdf explanation (payor). https://www.modahealth.com/pdfs/reimburse/RPM012.pdf

So if our facility is sending it out we can bill only the venipuncture but not the lab test cpt codes, I read that CMS does not use TC or 26 for venipuncture? 36415? Just wondering how the facility can get credit since they cant use a 90 modifier when we send out the labs. I looked at the link but it doesnt say anything about using TC with the venipuncture or how to bill the facility part. Thank you

 

[Alicia]

I have rather bad news. Over the holiday I reached out to some peers to confirm what I was finding. You bill 36415 alone and it is rather payer specific. Some payers will tell you it is bundled into the visit. There is no guideline to offer

 

[MistyR_46049]

I have rather bad news. Over the holiday I reached out to some peers to confirm what I was finding. You bill 36415 alone and it is rather payer specific. Some payers will tell you it is bundled into the visit. There is no guideline to offer

Thanks that is what I found too, that for OP they can bill 36415 if its sent out to a lab service but not both the venipuncture and labs. thank you so much