Oncology & Hematology Coding Alert

Question: Many lung transplantation (32851, Lung transplant, single; without cardiopulmonary bypass) patients come to our office for their blood work because our office is close to their work or home. In turn, we send the blood to the facility where the transplant occurred. Can we report any codes to bill for this blood work so we can recoup costs?

Wyoming Subscriber Answer:  For routine specimen collection services for Medicare beneficiaries, use G0001 (Routine venipuncture for collection of specimen[s]). For patients with private insurance, use either 36415* (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).
 
Use caution when reporting 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture), because the code requires that your physician perform an unusual venipuncture.
 
For example, if your nurse or phlebotomist were unable to obtain the specimen due to poor venous access, your physician would have to do the stick, and you would report 36410.
 
When the practice sends a specimen to a lab for testing, your physician may charge separately for drawing or collecting specimens as long as the fee doesn't exceed $3. You would submit one of the above-mentioned codes for your physician. Also, your physician will have to meet these criteria to bill for the work:

   Payers can't reimburse anyone who hasn't actually extracted the specimen.
   Your oncologist can bill only once per patient encounter, regardless of the number of specimens drawn.
   Other physicians in the region or local community where your oncologist practices also make separate charges for drawing specimens.
   Your physician bills separately for these services.