Consolidating billing medicare
The MAC may have told them that services listed as excluded under the SNF consolidated billing rules should be billed on a separate outpatient claim, type of bill (TOB) 85X.
Swing beds paid under the PPS use the minimum data set (MDS) form for data collection and facilities bill their services using a resource utilization group (RUG) and assessment indicator (AI) to identify the resource utilization and intensity of services.
Please refer to the coding section of this policy for the procedure code most applicable to the method of blood withdrawal.
This policy addresses the Health Plan’s reimbursement policies pertaining to clinical laboratory and related laboratory services (e.g., venipuncture and the handling and conveyance of the specimen to the laboratory) for professional provider claims submitted on a Form CMS-1500, whether performed in a provider’s office, a hospital laboratory, or an independent laboratory When blood is drawn to be sent to a reference lab, use code 36415 for the venipuncture. The most appropriate current code for G0001 is 36415 and the current fee for this is .00.
The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold Collection of a capillary blood specimen (36416) or of venous blood from an existing access line or by venipuncture that does not require a physician’s skill or a cutdown is considered “routine venipuncture Venipuncture Venipuncture is the process of withdrawing a sample of blood for the purpose of analysis or testing.
The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold.