Oncology & Hematology Coding Alert

You know that there is no margin for error when it comes to phlebotomy coding. You need to be sure you-re making the correct coding choice right out of the gate every time. Let our expert share some necessary tips to help ensure that you-re making the most from your coding.

When you-re coding for phlebotomy services, "choosing the wrong CPT code could result in a loss of revenue," says Janae Ballard, CPC, CPC-H, CPC-EM, PCS, FCS, ACS-E/M, revenue coding analyst at the Virginia Mason Medical Center in Seattle.

According to the current national reimbursement rates -- which are effective until July 1 -- you can lose $57.89 for each miscoded typical 99195 (Phlebotomy, therapeutic [separate procedure]) procedure and $3 per standard 36415 (Collection of venous blood by venipuncture) procedure, Ballard said during her recent presentation "Don't Get Stuck With Phlebotomy and Blood Draw Confusion" at The Coding Institute's 2008 Hematology Coding and Reimbursement Conference.

Keep your coding on the straight and narrow with this phlebotomy Q&A:

Question 1: A chemotherapy patient presents at your clinic for prechemotherapy labs. You note that she has an implantable venous port. The patient's labs are within normal levels, and your physician administers chemotherapy. What is the appropriate blood draw code for this encounter?

Answer: In this case, Ballard says, you should not report a blood draw code because you performed other services for the patient that day. You-ll find the CPT 2008 procedural notes for 36591 (Collection of blood specimen from a completely implantable venous access device) indicate bundling of this new code into infusion services.

Question 2: Your physician sees a patient with polycythemia vera (238.4) for his monthly therapeutic phlebotomy. What is the appropriate blood draw code?

Answer: Because this is a separate procedure -- and there was no other service provided the day of this procedure -- you-ll use normal therapeutic phlebotomy code 99195, Ballard says.

Question 3: One of your clinic's chemotherapy patients presents for her prechemotherapy labs. The patient has an implantable venous port. Her lab results show that her white blood cell count (WBC) is too low, so your physician decides to hold off administering her chemotherapy for a week. Under these circumstances, what is the appropriate blood draw code?

Answer: The correct code for this procedure will be new code 36591. Your practice didn't provide other services (such as chemotherapy) for the patient on that date of service, so reporting the blood draw code is appropriate, Ballard says.

Experts note: Don't charge 36591 if you perform any other billable service. Based on CPT guidelines, if your practice bills for the labs, you shouldn't charge 36591.

Resource: Ballard's recent presentation for The Coding Institute is available online at http://www.codingconferences.com/hematology08cds_doc_books.htm.