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Therapeutic phlebotomy

Kimberly Posted Fri 20th of January, 2012 15:15:47 PM

A patient is set to receive a transfusion due to a dx of homochromatosis, prior to the service the pathologist signs off on the pre phlebotomy assement stating the patient is ok to have a unit of whole blood removed. The pathologist wants to bill for his professional services with "99195-26". Is this the best code to use?

SuperCoder Answered Mon 23rd of January, 2012 12:16:38 PM

First of all we can't use modifier 26 with 99195 because it has PC/TC indicator "5".
Details of PC/TC idicator"5":
5 = Incident To Codes--This indicator identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes.

Secondly, for prephleobotomy assessment by a physician, I suggest an E/M code of lower level as it seemed appropriate.

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