Oncology & Hematology Coding Alert

Be sure to code only 1 collection fee per patient

Once you-ve determined that a blood draw is not actually therapeutic phlebotomy (99195, Phlebotomy, therapeutic [separate procedure]), you need to turn to the venipuncture codes -- and, in some cases, the lab testing codes.

If you-re sending your patients to an outside lab for both the blood draw and testing, you cannot report any blood draw codes. (You can, of course, code for the E/M service, such as a chemotherapy follow-up visit, in which your hematologist or oncologist ordered the draw.) If your practitioners collect the blood themselves, however, you have two options for coding the service, depending on where the blood goes next.

Outside: If the blood specimen that your practice collects goes to an outside lab for testing, report 36415 (Collection of venous blood by venipuncture) for the blood draw and the appropriate-level evaluation and management service code for the visit, says Tricia Katzberg, RHIT, CPC, CCS-P, coder for the Bend Memorial Clinic in Bend, Ore.

If the physician performed an E/M service and a nurse or ancillary staff member 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.

Example: The oncologist met with a cancer patient during a follow-up, had blood drawn 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.

Most Medicare carriers allow for one collection fee for each patient encounter, regardless of the number of specimens drawn. When a single test, such as a comprehensive metabolic panel (80053), requires a series of specimens, treat the collections as a single encounter. You would report 36415 once per encounter, while the laboratory is responsible for billing the different testing codes.

However: Check with individual payers on whether to use 36415 when it is part of a larger E/M visit. Some carriers may not allow you to bill it separately. Instead, the blood draw should be bundled as part of the E/M service.

Although the most frequently used code for blood draws is 36415, there are other venipuncture codes to consider, according to the June 1996 CPT Assistant. There is a family of codes you should use for venipunctures (phlebotomy) for obtaining blood specimens, starting with 36400 (Venipuncture, younger than 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).

Inside: If your practice has its own laboratory to perform blood tests, you can report the test along with the venipuncture. The lab must have Clinical Laboratory Improvement Amendments (CLIA) certification, and can only process CLIA tests, says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.

Example: An office staff member draws a Medicare patient's blood and performs a complete blood count (CBC) with platelet and WBC counts. Along with 36415, report 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count).

If the blood draw comes from a port, report 36540 (Collection of blood specimen from a completely implantable venous access device), Katzberg says -- but only for services rendered in 2007. CPT 2008 contains a new code (36591) for blood draw from an implanted device, and a new code (36592) for blood draw from a PICC or peripheral catheter. See "At Last -- a Code for Multiple Pushes of the Same Drug" in Vol. 10, No. 1 of Oncology & Hematology Coding Alert for more information.

Watch for: "The biggest problem I see is that the blood is drawn, but the blood draw is not documented," Parman says. "All patient services, including the blood draw, must be documented in the patient medical record.