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Thread Topic: Venipuncture
Topic Originator: Pam
Post Date January 15, 2009 @ 4:49 PM
Venipuncture


Pam
January 15, 2009 @ 4:49 PM Reply  |  Email Friend   |  |Print  |  Top

Most of the insurance companies will not pay for this.   If the patient is coming in for labwork and the nurse draws the blood, but he does not see the doctor, is it ok to bill 99211 for a nurses visit in this case?

Carol
January 16, 2009 @ 10:05 AM Reply  |  Email Friend   |  |Print  |  Top

Our office does not bill 99211.  We only bill the phlebotomy 36415.

Pam
January 16, 2009 @ 3:33 PM Reply  |  Email Friend   |  |Print  |  Top

Are you getting paid for it?  How about by Medicare.  I get it denied every time I file on it.

chris
January 23, 2009 @ 9:40 PM Reply  |  Email Friend   |  |Print  |  Top

Medicare pays us $3.00 for 36415

shelly
February 19, 2009 @ 5:20 AM Reply  |  Email Friend   |  |Print  |  Top

Is there anything special that you have to do to get paid by medicare for the 36415? I always have problems with this code. Sometimes they will pay this and other times it is denied for lack of information. It seems like it is denied more than it is paid. Do you have to have a referring provider when billing this?

lori
April 14, 2009 @ 8:33 PM Reply  |  Email Friend   |  |Print  |  Top

It is fraudulent to bill a 99211 for a venipuncture no matter who draws it.  You may only bill 36415.  I don't usually have a problem billing this along with separate e&m codes, unless other procedure such as a urine dip or injection have been done. In this situation, append mod 59 to the 36415.  The only way you may bill a 99211 in addition to the venipuncture is if a separate reason is given, such as a blood pressure check in which changes or recommendations need to be given. If a nurse assesses a patient complaint during the encounter and it requires actual advise or instruction you may also bill a 99211.  I wouldn't recommend looking for a reason for a 99211 due to risk of penalty and fraud abuse in an audit.  This is what I have heard at more than one coding conference regarding audits.

  Yes a referring provider is needed.

Mark
April 17, 2009 @ 6:07 AM Reply  |  Email Friend   |  |Print  |  Top

Hi Pam,

You can bill 36415 and shouldn't bill 99211 please look at the below information and medicare will surely cover 36415

CHANGE FOR MEDICARE VENIPUNCTURE CODE
G0001 (Medicare code for venipuncture) is being deleted and replaced with 36415, effective Jan. 1st. The service will continue to be payable under the lab fee schedule. Carriers will be able to pay correctly for the use of 36415 for venipuncture by Jan. 1 when the new fee schedules take effect, according to CMS. Medicare used to cover venipuncture with code 36415, but implemented the G code because 36415 included collection of blood through the finger, heel or ear stick - all services not covered by the program.

But a distinct CPT code, 36416, was created in 2003 to bill for the parts of the venipuncture service not covered by Medicare. That code will remain non-covered, CMS says. The agency is making a late switch back to 36415 because the definition of the code now matches the definition of G0001, a CMS official says. Routine venipuncture with 36415 is a "simple" blood draw that does not require the physician's skill. Remember, you shouldn't bill for a 99211 ($21.28, par, national, office) unless you have a medically necessary reason other than the venipuncture.

lori
April 24, 2009 @ 8:39 PM Reply  |  Email Friend   |  |Print  |  Top

Since you mentioned 36416, I know Medicare will not cover this.  However, many insurances will cover this fingerstick code with glucoscan and pt/inr finger stick testing, or any other fingerstick testing.  The average pay is $7.00 for this code.

Kelly
May 11, 2009 @ 4:11 PM Reply  |  Email Friend   |  |Print  |  Top

I have an insurance company wanting to deny charges for 36415 collection of venous blood by venipuncture on a 2007 case. They state that "services routinely required to perform a procedure are included in the cost of the specific lab test."

Is this correct or is 36415 billable?  I am having difficulty finding definative direction in this matter.

Thank you

nanette
March 30, 2015 @ 12:16 PM Reply  |  Email Friend   |  |Print  |  Top

Hi ,I have question how to bill medicare on venipuncture . This is how i do by using 36415 still medicare will not pay . Please advise me whatelse do i do wrong .

Thank you



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