In primary care, it’s easy to focus on office visits and routine evaluations, but many practices overlook the importance of accurately billing for ancillary procedures like venipuncture, EKGs, and other peripheral services. These additional services may seem minor, but they contribute significantly to a practice’s revenue. Ensuring that these procedures are billed correctly can make a substantial difference in maintaining financial health.
In this blog, we’ll explore the best practices for billing common ancillary services, including venipuncture, EKGs, and more, so your practice can capture the full reimbursement you’re entitled to.
1. Billing for Venipuncture (CPT 36415)
Venipuncture, or the drawing of blood, is a routine procedure in primary care. However, some practices fail to bill for it separately, leaving money on the table. Venipuncture is commonly billed under CPT code 36415, which represents the collection of a blood specimen through venipuncture.
Key Considerations:
Ensure that venipuncture is billed separately from the office visit. This procedure is typically not included in the Evaluation & Management (E/M) codes and should be billed in addition to any office visit or diagnostic service.
Medicare and many private payers cover venipuncture as a distinct service. Be sure to check payer policies for specific rules or bundling requirements.
Best Practice:
Train your staff to accurately document venipuncture and submit it separately. Ensure it's listed as an additional procedure when billing for other services during the same visit.
2. EKG Billing (CPT 93000, 93005, 93010)
Electrocardiograms (EKGs) are another common ancillary service that must be billed correctly to ensure proper reimbursement. EKG billing can be a bit more complex due to the different codes that apply, depending on what services are provided.
CPT 93000: This code is for complete EKG services, including both the technical and professional components (i.e., the test itself and the interpretation by the physician).
CPT 93005: Use this code if you’re billing for just the technical component (performing the test).
CPT 93010: This code is used for the professional component only (interpreting the EKG results).
Key Considerations:
Make sure you’re billing for both the technical and professional components when applicable. If another physician or facility interprets the results, be sure to use the appropriate split code (93005 or 93010).
Check with insurers to ensure that EKG services are not bundled into the office visit, as some payers may have specific rules regarding bundling.
3. Billing for Other Peripheral Services
In addition to venipuncture and EKGs, primary care practices often perform other ancillary services that need to be billed appropriately. These can include:
Spirometry (CPT 94010): Spirometry, a common test for lung function, is typically billed under CPT 94010. Make sure the procedure is not bundled into an office visit code and is billed separately.
Urinalysis (CPT 81000-81003): Routine urine tests are frequently performed in primary care. Each type of urinalysis, whether with or without microscopy, has its own CPT code. Be sure to document the specific type of test performed to avoid denials.
Injections (CPT 96372): For injections like vaccines, medications, or therapeutic agents, use CPT 96372. This represents therapeutic injections administered by the physician or staff, and should be billed separately from the office visit or E/M code.
Best Practice:
Bundling Awareness: Many payers bundle ancillary services into routine E/M codes. Ensure your billing team reviews each payer's policy to understand which services can and cannot be billed separately.
Documentation: Always provide clear documentation for every ancillary service performed. Include details such as the time, date, and the specific service provided, so your billing team has the correct information for coding.
4. Combining E/M Codes with Ancillary Services
One of the most important aspects of billing for ancillary services is knowing how to properly combine these procedures with the Evaluation & Management (E/M) codes for office visits. The key is ensuring that the ancillary services are billed separately from the office visit when applicable and justified by documentation.
Best Practice:
Use Modifier 25 when necessary to indicate that a separate, significant E/M service was performed in addition to the ancillary procedure.
Always make sure the ancillary service isn’t included in the office visit or bundled with the E/M code, which can lead to denials.
Conclusion: Maximize Revenue by Properly Billing Ancillary Services
Ancillary procedures may seem minor compared to office visits, but they can significantly impact your practice’s revenue. Ensuring that procedures like venipuncture, EKGs, and spirometry are billed correctly is essential to capturing all the revenue your practice is entitled to.
By training your staff, reviewing payer policies, and ensuring accurate documentation, your practice can avoid common billing mistakes and maximize reimbursement for these valuable services. Don’t overlook the importance of ancillary billing—each correctly submitted claim contributes to the financial health of your practice.
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