Medicare Compliance & Reimbursement

Question: Our lab collects capillary blood by fingerstick for certain tests rather than venipuncture. Can we expect payment for this service?

AAPC Forum Participant

Answer: You probably can’t expect reimbursement for fingerstick blood collection, even though CPT^® provides a code for the service — 36416 (Collection of capillary blood specimen (eg, finger, heel, ear stick)).

Most payers, including Medicare, assume the exam or test procedure includes the cost of most simple specimen collection procedures, such as fingerstick, urine cup collection, or culture swab. Many payers do cover the cost of a routine venipuncture blood draw — 36415 (Collection of venous blood by venipuncture). However, payers may have specific rules about which entities may bill the venipuncture and under what circumstances.

Don’t miss: You may bill for more complicated specimen collections that require special services, such as some of the following:

36400 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein)

• 36405 (… scalp vein)
• 36406 (… other vein)
• 36410 (Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture))
• 89230 (Sweat collection by iontophoresis)
• 89220 (Sputum, obtaining specimen, aerosol induced technique (separate procedure)).