Oncology & Hematology Coding Alert

Question: What is the appropriate code for a blood draw when drawing from an AV fistula? Is it the same code that is used to report a blood draw from a central line? California Subscriber Answer: Using an AV fistula for a blood draw usually falls into the realm of taboo, and it should only be used in a life-and-death situation if no other access is available and requires specially trained nursing staff or an MD.

There is no indication of the reason for the blood draw, and payers may need to decide whether this constitutes venipuncture, arterial puncture, or catheter access into the dialysis graft. If you are accessing the AV fistula for dialysis and drawing off blood samples, there is no separate charge. Simply use 36415* (Routine venipuncture or finger/heel/ear stick for collection of specimen[s]). The hemodialysis section of the CPT book instructs the reader to use 36540 when describing the collection of blood specimens from a partially or completely implantable venous access device. The AV shunt is a whole different animal and is usually not accessed for a simple blood draw.

If the blood is drawn as part of a more comprehensive procedure, it may not be separately coded. Answers to the Reader Questions and You Be the Coder were provided by Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.