3 Reasons Why Medical Providers Should Bill Specimen Handling Code

What is specimen handling?

Specimen handling involves collecting, preserving, and transporting specimens (such as blood or urine) sufficiently and stably to provide accurate and precise results suitable for clinical interpretation.

1 Specimen Handling is essential for patient care

When a patient presents with an ailment, the physician’s role is to order the appropriate laboratory tests that play a pivotal role in the final diagnosis of the disease and its management. The maximum accuracy of these diagnostic results begins with the accuracy of the staff handling the specimen. The back-office staff operating the samples should know and follow proper sterile techniques and guidelines for carefully collecting and disposing contaminated specimens and other biological material.

Except for certain medical facilities and practices, this is a necessity if they do not have the medical equipment required to perform clinical interpretation. The most common tests often requiring an outside laboratory to process are: 

  • Throat cultures
  • Mono spots
  • Urinalyses
  • STD panels
  • Obesity panels
  • Blood typing
  • PCR

While some practices have invested in the equipment they feel necessary for their practice; many others find it more advantageous to outsource this workflow to free up their resources.

2 You can get paid up to 60% of your fee

Some insurance companies reimburse up to sixty percent of the amount billed, but this depends on each contract between insurance companies, the diagnosis code, and other variables such as the patient’s out-of-pocket expenses, deductible, or co-pays. A majority of insurance companies deny the procedure as inclusive with no patient responsibility. However, all is not lost. Physicians can and should profit from this service which takes up staff time and resources. Here’s how:

  • Create a set fee for specimen handling
  • Keep track of the schedule that your nursing staff sees as lab visits only.
  • Have a waiver ready for the patient to sign. The waiver must state clearly why the patient signature is needed and must include the CPT code and fee.
  • Collect payment upfront 
  • Run reports often to track revenue for this service

*Please note that Medicare and Medicaid patients are excluded from the above. Check CMS guidelines for further information.*

3 Specimen handling in-office decreases anxiety of going to an outside lab

When patients visit their physicians for a suspected illness, they often already have reservations and fears of what their condition may be. They hesitate in just scheduling the visit. If a patient enters your office with anxiety, they can be irritable or have difficulty remembering instructions given to them for treatment. Furthermore, as providers of care, an environment must be created to reduce these symptoms.

 One of the tactics in reducing anxiety symptoms is making things as convenient for the patient as possible. If the need to visit an outside laboratory is one of the factors in your patient’s anxiousness, you can quickly eliminate that factor by collecting the specimen in your office.

What is the CPT code for specimen handling?

The CPT code for specimen handling is 99000. Depending on the specimen collected, the code can be billed to insurance alone if the patient did not see the doctor during the visit. Otherwise, make sure your billing staff bills out HOW the specimen was collected (e.g., Via venipuncture or fingerstick), as payment should be expected on those services as well.

Which insurance companies pay for specimen handling?

Currently, there are too many insurance companies available to give a generalization of reimbursement. However, based on the companies that we have worked with, UMR/UnitedHealthcare stands alone in payment on this procedure. Consequently, this evaluation was dependent on specific diagnosis codes we linked to 99000.

 Be aware that depending on the patient’s coinsurance, out-of-pocket expenses, deductible, or diagnosis code responsibility may be transferred to the patient. 

Always stay in the loop of provisions to your contracts with insurance companies regarding policies like these. It could mean a loss or a gain in revenue for your practice!

Protecting your brand while you save lives!

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