Pathology/Lab Coding Alert

Question: Our hematopathologist performed a therapeutic phlebotomy in the office for a patient with polycythemia. Should we report a physician venipuncture code such as 36425?

Colorado Subscriber

Answer: No, you should not report the service with 36425 (Venipuncture, cutdown; age 1 or over) or any code in the venipuncture range 36400-36425. These codes describe physician-performed venipuncture based on the method the physician uses to collect a blood sample.

What you’ve described is therapeutic phlebotomy, which you should report as 99195 (Phlebotomy, therapeutic (separate procedure)).

What it is: A therapeutic phlebotomy is similar to a blood donation except that it is done as a treatment approach. When done for polycythemia, it helps to reduce the blood cell mass.

Caution: For a therapeutic phlebotomy in an inpatient or outpatient setting, the hospital — not the physician — should bill for the service, because the hospital provides the space, equipment, and personnel to perform the service.

Do not forget the diagnosis codes: For polycythemia, you’ll default to D75.1 (Secondary polycythemia).