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36415 incidental to labs drawn

Rhonda Posted Fri 01st of November, 2013 10:33:01 AM

lately i have been receiving denials for code 36415, they are saying its coincedental to procedure which would be the labs we had drawn for that day, has something changed?

SuperCoder Answered Fri 01st of November, 2013 12:01:42 PM

CPT code '36415' is only eligible to be billed once, even when multiple specimens are drawn. Often payers do not allow separate reimbursement for '36415' when billed in conjunction with a blood or serum lab procedure performed on the same day and billed by the same provider ('80048-89399' range.) '36415' will be denied as a subset to the lab test procedure. Make sure you put a -25 modifier when an office visit and venipuncture are coded together. Often payers allow separate reimbursement for '36415' when the only other lab services billed for that date by that provider are for specimens not obtained by venipuncture (e.g. urinalysis).

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