Lab Code Lowdown: Use G0001 for Medicare Only

Coders can find it difficult to select the appropriate code for a blood draw because different rules apply for Medicare and for private payers. Never fear - you can choose the right code every time by following these two simple steps:
 
1. Determine whether the patient is a Medicare beneficiary. If you are billing Medicare for your lab's services, you have only one code available for blood collection: G0001 (Routine venipuncture for collection of specimen[s]). Law mandates that Medicare cover venipuncture but does not require coverage for collection of a capillary blood specimen (such as a finger or heel stick), says Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla.
 
If your office performs a finger stick or other capillary collection on a Medicare patient, the service is simply not billable, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. For collection of a venous blood specimen on a Medicare patient, report G0001 along with the appropriate lab test codes.
 
2. Identify whether the blood collection was from a vein or capillary. There are only two major codes to choose from when you bill blood collection services to a private payer: 36415 (Collection of venous blood by venipuncture) and 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]). Selecting the right code is as simple as knowing the source of the collected specimen. Always report the appropriate blood collection code along with any lab test codes, Dettwyler says.

- Published on 2004-08-26