Description:
The following policy addresses Blue Cross and Blue Shield of North Dakota’s (BCBSND) guide for billing venipunctures and lab handling.
Definitions:
Codes 36415 and 36416 are for the collection of blood for lab testing.
Code
|
Description
|
36415
|
Collection of venous blood by venipuncture
|
36416
|
Collection of capillary blood specimen (e.g., finger, heel, ear stick) |
Code 99000 is the charge for the services needed to transfer a specimen.
Code
|
Description
|
99000
|
Handling and/or conveyance of specimen for transfer from the office to a laboratory |
Policy:
Code 36415 is submitted when the provider performs a venipuncture service to collect a blood specimen(s).
As opposed to a venipuncture, a finger/heel/ear stick (36416) is performed in order to obtain a small amount of blood for a laboratory test.
These codes should be billed only once regardless of the number of tests performed from that specimen.
Code 99000 is an adjunct code submitted to indicate handling and/or conveyance of a specimen for transfer from the practitioner’s office to a laboratory. This code should never be used for lab services performed completely within the practitioner’s office.
If the lab is picking up the specimen, there is no handling cost incurred and the clinic should not bill 99000.
The test that is being done from the specimen must be indicated on the claim. If sending the test to an outside lab the -90 modifier must be appended to the test code (if you are billing for the test) or narrative indicating the test code and/or name. If this information is not present on the claim, the charge will be denied if billed in addition to a venipuncture code 36415.
For lab tests requiring routine venipuncture and subsequently sent to an outside lab, the physician office may bill either the venipuncture service or the handling charge, but not both. Only 36415 or 99000 may be billed.
Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:
- Group or Individual benefit
- Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
- Mandated or legislative required criteria will always supersede.
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
History:
Date
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Updates
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12/24/2020
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Minor wording revisions made to the description section.
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