CPT Code 99000. What should you know before using it?
Discover billing insights for OBGYN practices, focusing on proper coding for STI testing, contraceptive counseling, and maximizing reimbursements efficiently.
OB/GYN Medical Billing & Coding Alert
Question In Concern: We have numerous patients who self-swab for sexually transmitted infection (STI) testing. One patient was counseled on all available contraceptive options and chose to receive a prescription for birth control pills. We have been billing for codes 99211, 99000, and 36415; however, we only receive payment for the 36415 and 99000, totalling less than $10.
Question: Is it advisable to bill a 99212 instead? Do you have any recommendations?
Answer For Think Twice Before Reporting 99000
The key question to consider is: Who sees the patient? Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified healthcare professional) is typically used for visits that do not necessitate a physician's or qualified healthcare professional's presence. This code is often applied to visits with registered nurses (RNs). If the patient met with the RN only, you should not report 99211; if they saw a physician or nurse practitioner, then 99211 would not apply.
Suppose counselling was the only other service provided. In that case, you should use codes 99401-99404 (Preventive medicine counselling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)) for this service.
Additionally, consider why you are billing for 99000 (Handling and/or conveyance of specimens for transfer from the office to a laboratory). If the patient is collecting the swab and your practice is only responsible for labelling the sample for lab pickup, this code may not be appropriate.
Code 99000 has no relative value units (RVUs) assigned, meaning payment is determined solely by the payer. It was originally designed to cover costs related to using lab equipment to prepare and transport specimens to the lab, not for routine labelling and placing samples in a lab box for collection.
If your practice collects a blood sample for laboratory testing, you can bill for 36415 (Collection of venous blood by venipuncture). Like 99000, this code lacks assigned RVUs, resulting in low reimbursement rates.
Key Considerations For Billing 99000 Provided Answer
Patient Interaction
Who is seeing the patient?
- Code 99211 is used for visits that may not require a physician or qualified healthcare professional.
- This code is typically for registered nurse (RN) visits.
- If the patient only met with the RN, do not report 99211.
- If the patient saw a physician or nurse practitioner, you should not use 99211.
Counselling Services
If counselling was the only service provided:
- Use codes 99401-99404 for preventive medicine counselling and/or risk factor reduction interventions.
Specimen Handling (Code 99000)
Evaluate the necessity of billing 99000 (Handling and/or conveyance of specimen):
- This code is applicable when the practice handles specimens beyond routine labelling.
- If the patient collects the swab and your practice only labels it for pickup, do not bill 99000.
- 99000 has no relative value units (RVUs), and payment is payer-determined.
Blood Sample Collection (Code 36415)
You can bill 36415 for the collection of venous blood by venipuncture:
- This is applicable when your practice collects blood for lab testing.
- Note that 36415 also has no assigned RVUs, resulting in low reimbursement rates.
Summary
- Ensure proper coding based on who the patient sees and the services provided.
- Use appropriate codes for counseling and specimen handling.
- Be mindful of low reimbursement for certain codes.
BillingFreedom: An Ultimate Resource for Reporting 99000 and OBGYN Medical Billing Services
At BillingFreedom, we pride ourselves on being experts in OBGYN medical billing services, equipped with comprehensive training and in-depth knowledge of coding regulations. Our skilled team understands the nuances of patient interactions, ensuring accurate billing based on who the patient consults—an RN or a physician. We are adept at handling preventive medicine counseling and navigating complex specimen handling codes, including 99000, maximizing reimbursements while minimizing denials.
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