Oncology & Hematology Coding Alert

Question: Our oncology surgeon did a therapeutic phlebotomy in a patient with polycythemia. Should I use 36415 and code it as a venipuncture?

Colorado Subscriber

Answer: You do not report codes 36415 (Collection of venous blood by venipuncture) for therapeutic phlebotomy. This code is for venipuncture, which a provider performs in the office to collect a blood sample from a patient to use in lab testing.

Instead, as its descriptor states, you report code 99195 (Phlebotomy, therapeutic (separate procedure)) for a therapeutic phlebotomy,

 What is therapeutic phlebotomy? A therapeutic phlebotomy is a blood draw, but it is done specifically for therapeutic reasons and not diagnostic purposes. When a provider performs it for a patient with polycythemia, it is done to help to reduce the blood cell mass. This, in turn, helps the blood flow more easily in the patient’s body as it reduces blood volume and thickness.

Don’t forget the diagnosis code: Depending on the type of polycythemia, you will assign one of the following ICD-10-CM codes:

• D45 (Polycythemia vera)
• D75.0 (Familial erythrocytosis), which includes such conditions as benign polycythemia and familial polycythemia
• D75.1 (Secondary polycythemia), which includes such conditions as acquired polycythemia, emotional polycythemia, and polycythemia due to high altitude or stress

Watch out: If therapeutic phlebotomy is performed in an inpatient or outpatient setting, the hospital — not the physician — should bill it because the hospital provides the space, the personnel, and the necessary equipment to perform the service.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC