Q&A Urgent Care Billing

[rajah]

I am working on an A/R project and I've noticed that BCBS is denying cpt code 36415 as inclusive with 85025. Not sure if I'm supposed to submit an appeal or adjusting it off as inclusive. Thank you

 

[Laura E. Duncan]

I am new to coding, preparing to sit for CCA certification and I now have the 2013 Blitz-Video to help prepare me for CPC-P certification. If I understand the two CPT codes correctly, CPT 36415 is for drawing the blood while 85025 is for doing the diagnostic testing on that drawn blood. If that is correct, I don't understand why 36415 is being denied either. Many small practices have no in-house laboratory services. They outsource their draws for analysis. The Dr. should not have to write off the cost for utilizing phlebotomy skills of on-staff MAs.
I will be very interested in learning the answer to why BCBS is denying it.

 

[Kathy O'Neal]

I'll be very interested in the answer you get. I'm going thru the same thing.

 

[Ruth Sheets]

Laureen discussed this topic in the September 2013 Q&A Webinar. In case you don't know, you may view the replay of this webinar, as well as all the replays from the past, when you join the CCO Club.

Laureen said that there were no CCI edits using 36415 with 85025, but perhaps BCBS is one of the payers who bundle these codes or they bundle one of them with an EM code. She suggested appealing the denial.