Oncology & Hematology Coding Alert

Question: The oncologist took a blood sample from a patient with skin cancer during a follow-up visit. We reported 99195 (Phlebotomy, therapeutic [separate procedure]) and were denied. Why? Isn't this procedure a phlebotomy?


Arkansas Subscriber


Answer: While the procedure you described is often referred to as a phlebotomy, you should not use the therapeutic phlebotomy code when the doctor draws blood during a follow-up visit. On your claim, you should have done one of two things:

Option 1: You could have reported 36415 (Collection of venous blood by venipuncture) for the blood draw and the appropriate-level evaluation and management service code for the visit.
 
If the physician performed an E/M service and collected blood from the patient, look for additional information on the claim that makes the encounter at least a level-two (and sometimes a level-five) service.
 
Let's say the oncologist met with the skin cancer patient, drew blood for analysis and provided level-four E/M service. On the claim, report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M service, and report 36415 for the blood draw.

Option 2: You might report a lab test code, such as:

85025 - Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count) or

85027 - ... complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count). Use Option 2 only if your office performed the lab work in the office after the blood draw.

You're probably best served by calling your carrier before filing the claim and asking how it wants you to report the encounter.

So what's 99195 for?: CPT designed code 99195 to report encounters in which the physician addresses a specific blood-related problem. 

"Code 99195 represents a therapeutic phlebotomy, often used in the treatment of polycythemia vera [ICD-9 code 238.4] to reduce the hematocrit and red blood cell mass. Therapeutic phlebotomies are used in the treatment of other diseases as well," according to CPT Assistant, June 1996. Other venipuncture codes to consider: There is a family of codes you should use for venipunctures (phlebotomy) for obtaining blood specimens, starting with 36400 (Venipuncture, under age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein) and ending with 36425 (Venipuncture, cutdown; age 1 or over).

The most frequently used code is 36415, but you may also use one of the codes from the 36400-36425 series for blood collection, according to CPT Assistant.  - Clinical and coding expertise for this issue of Oncology Coding Alert provided by Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies  [...]