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Chris Posted 7 Year(s) ago

When you take a throat culture can you charge 87081 for obtaining a specimen? or is that included in the E&M? We do charge for the 99000 on all cultures since we do not have a lab in office and have to transport our sample to the hospital lab.

SuperCoder Posted 7 Year(s) ago

If a patient is asked to come into the office to have a throat culture performed, there has to be documentation in the chart the physician requested it:
- bill an E/M in case of a face-to-face encounter with the physician,
- in the absence of face-to-face encounter - it could be a notation in the chart the physician
talked to the patient by phone and asked the patient to come in.

(1) face-to-face encounter: bill the appropriate E/M service, and CPT 99000 for lab handling. There is no CPT code for 'swabbing the throat.'

(2) No face-to-face encounter, but is on site and the MA swabs the throat: Bill a 99211 and 99000. The 99211 would be for the documentation in the note the patient spoke to the doctor by phone to support the need for the throat culture, saw the MA - vitals were taken and chief complaint documented, and the throat was swabbed.

There are unique circumstances where you can bill for the throat culture with the 80000 series CPT's - but that is only when the physician has a contract with a lab to submit specimens, but handle the billing internally. This arrangement cannot be with Medicare or Medicaid.
You need to know the billing arrangement with the lab first, before you code for the encounter.

General Guidelines to bill 99000
CPT code 99000, "Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory," is intended to be reported when the practice incurs costs to handle and/or transport a specimen to a lab. For example, if the practice employs a messenger service to transport a specimen, that service can be coded using 99000. In comparison, if lab staff pick up a specimen at no additional cost to the practice, it would not be appropriate to report code 99000 for reporting the obtaining of a specimen.

However, 99000 may be used to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory (e.g., centrifuging a specimen, separating serum, labeling tubes, etc.). For in-office tests, you should submit only the appropriate code for the test itself. Note that Medicare and many other payers consider code 99000 to be a bundled service that is not separately payable.

Posted by Chris, 7 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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