Medical Billing Forum

Billing => Billing => Topic started by: alaskanannie on March 30, 2011, 01:56:48 PM

Title: Billing 36415 & 80050 together
Post by: alaskanannie on March 30, 2011, 01:56:48 PM
I have an insurance company who is denying 36415 as inclusive to 80053 when I bill them together.  All other insurances pay these separately.  I have found nothing in the Coding book which will help me to definitively appeal the billing of these two codes together.  Can anyone help me with this?
Thanks!
Title: Re: Billing 36415 & 80050 together
Post by: Michele on March 31, 2011, 09:11:22 AM
Sounds like it may be a plan exclusion.  Have you spoken to a customer service rep?  I would start there.  If I don't like the explanation I would contact a provider rep to discuss.
Title: Re: Billing 36415 & 80050 together
Post by: alaskanannie on April 01, 2011, 06:31:48 PM
The customer service rep states that the venipuncture is included in the charge for the GHP which is not indicated in the CPT code book and all other insurance companies except Wells Fargo Insurance Svcs & Aetna pay as separate charges.  Generally, I appeal with copies of the CPT code book indicating that they are billable separately but there is nothing in the book one way or the other.  It's the interpretation that I'm fighting here so I'm trying to find something concrete to use in an appeal.
Title: Re: Billing 36415 & 80050 together
Post by: Michele on April 01, 2011, 06:58:38 PM
I don't know of any documentation to support your appeal.  Sorry!  :(