medicbilling

Coding Clarification – 99000 Mis- and Over-Use

In Uncategorized on August 22, 2013 at 6:32 pm

Upon a recent audit of provider claims, MEDIC, Inc. identified an apparent overuse of 99000.  As such, M.E.D.I.C., Inc. feels that there is a general need to clarify the use of CPT code 99000.  This code should NOT be used when a blood sample is drawn at the office and sent out to the lab.  Rather the 99000 should be used if a specimen is collected (for example cultures of wounds, urine, C&S) for a lab test done at an out lab.

When reviewing revenue detail reports related to the 99000, it is evident that few 99000 claims are actually paid, and those that were were classified as self pay (i.e., they were patient responsibility, not billed to insurance).

Additionally, this code is not billed as a stand-alone code—it is always with an office visit – and when the 99000 is charged with an office visit, rarely if ever does one see a payment.  Per the CCI edits, it is deemed inclusive to the office visit.  In fact, Medicare does not even include the 99000 on their fee schedule.

You can certainly continue to use this code, but most carriers are going to follow the CCI edits and refuse to pay it, and you will not have any basis for appeal.  It is inapproptiate to merely attach the -25 modifier.  Essentially, this code is used primarily for reporting purposes rather than reimbursement.

Please see the following comments addressing the 99000 as well:

  • AMA Comment:  The codes listed in the special services, procedures and reports section (99000-99091) identify various services and reports that are adjunctive to the basic services rendered. These codes describe circumstances under which practitioner services are performed.

Modifier -25 indicates that a separately identifiable E/M service was performed on the same day as another independent procedure or service by the same physician. When a code from the special services, procedures and reports section is reported with an E/M service, modifier -25 should not be appended to the E/M service, as the codes from the 99000-99091 series do not describe separately identifiable services, but rather adjunctive services or circumstances that further describe the basic service rendered.

  • From the AAFP Website:  Most people use 99000 incorrectly. It is not used for obtaining a specimen.  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 contrast, if lab staff pick up a specimen at no additional cost to the practice, it would not be appropriate to report code 99000. 

Finally, 99000 is not intended for reporting the obtaining of a specimen.  Reimbursement for obtaining a Pap smear or a throat culture is factored into the relevant lab procedure code.  Obtaining a blood specimen by venipuncture may be reported separately, using code 36415, “Routine venipuncture or finger/heel/ear stick for collection of specimen(s).”  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.

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