Oncology & Hematology Coding Alert

Confuse phlebotomy with blood draws, and risk losing $57 each time Therapeutic phlebotomy is most often associated with the hematology side of oncology practices. But coders sometimes confuse the procedure with blood draws that are common in follow-up care for chemotherapy. And coding the wrong service in the wrong situation will probably lead to denials. And with $57.60 at stake for 99195 (Phlebotomy, therapeutic [separate procedure]) in 2008, denials can be costly. That's 1.52 transitional non-facility RVUs, using the 2008 Medicare Physician Fee Schedule, multiplied by conversion factor 37.8975. Here's how to conquer coding confusion between phlebotomies and blood draws. Use 99195 for Therapeutic Phlebotomy Only Your colleagues may use the word "phlebotomy" to refer to a blood draw for testing purposes, but be careful -- you should only use code 99195 to describe therapeutic phlebotomy, says Janae Ballard, CPC-EM, ACS-EM, revenue coding analyst at the Virginia Mason Medical Center in Seattle. What's the difference? "Code 99195 represents a therapeutic phlebotomy, often used in the treatment of polycythemia vera [ICD-9 code 238.4] to reduce the hematocrit and red blood cell mass. Therapeutic phlebotomies are used in the treatment of other diseases as well," according to the June 1996 CPT Assistant. Sometimes known as "therapeutic bleeding," the procedure involves "a controlled removal of a large volume (usually a pint or more) of blood," according to Aetna's clinical policy bulletin on therapeutic phlebotomy. "It is used mainly to reduce blood volume, red cell mass and iron stores." So, your payers will likely be looking for a specific diagnosis from a list of ICD-9 codes that support medical necessity for the phlebotomy procedure. Blue Cross and Blue Shield of Montana's list of acceptable diagnosis codes includes: - 238.4 -- Polycythemia vera - 238.7x -- Neoplasm of uncertain behavior of other and unspecified sites and tissues; other lymphatic and hematopoietic tissues - 275.0 -- Disorders of iron metabolism - 277.1 -- Disorders of porphyrin metabolism - 285.0 -- Sideroblastic anemia - 289.0 -- Polycythemia, secondary. Caution: Different payers will have different criteria. Be sure to check with the individual payers for their own lists of diagnoses supporting medical necessity. A physician does not have to perform the procedure and may bill for an office-performed therapeutic phlebotomy by a midlevel provider as "incident-to" his professional services, as long as it was performed under physician supervision and he can show active management of the patient's treatment. If therapeutic phlebotomy is performed in an inpatient or outpatient setting, the hospital should bill it because the hospital provides the space, personnel and equipment. Documentation: To further prove medical necessity, the record must include documentation describing the condition being treated, the procedure for each date of service, and the [...]