Pathology/Lab Coding Alert

Question: As in independent laboratory, can we charge for blood draws made by our phlebotomist when patients go to the lab for specimen collection? Can we make referral arrangements with physicians' offices for the blood-draw services?


Connecticut Subscriber


Answer: Yes, you can charge for blood draws made by the phlebotomist at your lab. The most common type of blood collection is venous puncture, which you should report as 36415 (Collection of venous blood by venipuncture).

Use 36415 for both Medicare and other payers. Prior to Jan. 1, 2005, you reported venipuncture to Medicare using G0001 (Routine venipuncture for collection of specimen[s]). But the Clinical Laboratory Fee Schedule included 36415 instead of G0001 beginning this year. Notice that Medicare still does not pay for blood collection by capillary puncture (36416, Collection of capillary blood specimen [e.g., finger, heel, ear stick]).
 
Regarding the second part of your question, be careful when you make referral arrangements with physicians because you might be violating the anti-kickback statute.

A laboratory recently asked for an advisory opinion from the HHS Office of Inspector General regarding laboratories making blood sample collection arrangements with physicians. Some referring physicians told the laboratory that they want to draw their patients' blood during office visits and have the laboratory pick up the specimens at the office, instead of sending their patients to the laboratory, the OIG says.

Mistake: The laboratory would provide the blood collection supplies at no charge to the physicians and pay them for each patients' blood draw, while still submitting the full claim for the blood collection and specimen handling to insurers, including Medicare and Medicaid.

Because the laboratory proposed to pay the physicians more than what Medicare reimburses for blood drawing services and supplies, the arrangement would provide a strong financial incentive for physicians to order more tests and make referrals to the lab, the OIG maintains. This would violate the anti-kickback statute.

A laboratory can't also bill Medicare for services, such as blood specimen collection, provided by anotherperson or entity, because this violates the False Claims Act, the OIG says.

To read the advisory opinion, go to www.oig.hhs.gov/fraud/docs/advisoryopinions/2005/ao0508.pdf.