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Charging for ped straight cath for specimen collection

Debra Posted Wed 21st of January, 2015 17:35:59 PM

Can ED facility charge for specimen collection such as urine straight cath or venipuncture separate charges?

SuperCoder Answered Wed 21st of January, 2015 18:05:52 PM

Thank you for your question.

These may be billed/coded out from the ED, but typically are not reimbursed. They are considered inclusive to the ED service. They will typically not be denied, but will show no reimbursement.

Debra Posted Tue 27th of January, 2015 18:45:23 PM

As a continuation of this question, it is my understanding that we should be consistent in our charging across the board not dependent on the payor. Since venipuncture and straigh cath is for the purpose of collecting specimens for testing and the insurance companies won't pay for it even if we charge for it. Why would anyone want to charge for it anyways? It doesn't seem right if a patient is a self pay with no insurance that they have been charged for it but someone with insurance it won't get paid. So why charge it at all if it is considered inclusive to the ED service. That's seems as if that would be unbundling and a facility should NOT be allowed to charge for it at all.

SuperCoder Answered Mon 02nd of February, 2015 10:59:55 AM

Compliance and contracts with payers do not allow for what can be billed for whom based on the payer. Services must be coded/billed as performed. It would be non compliant to waive charges for self pay and bill those charges for patients with insurance. You are correct that charges should be consistent. For coding compliance, if a service is performed it needs to be coded. It is not unbundling charges as ED visits do not include such services as cath/venipuncture/etc. as part of the code descriptor or service.

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