Oncology & Hematology Coding Alert

Question: We are a new outpatient cancer center and just started to draw blood. We are attached to a hospital that has a lab. We draw blood and then send it to the lab to be processed. Expenses are incurred for the supplies. Can we charge for the blood draw?
          
Colorado Subscriber
      
 Answer: How a practice codes for routine blood draws depends largely on whether it has its own laboratory or sends samples to an outside lab. Choosing the correct  codes depends mostly on the kind of insurance the
patient has.
 
Although testing is done by an outside lab, in some instances practices can still bill for the drawing of blood.
 
The proper codes include 36415 (routine venipuncture or finger/heel/ear stick for collection of specimen[s]); G0001  (routine venipuncture for collection of  specimen[s]); 99211 (office or other outpatient visit); or the laboratory test code, such as 85022 (hemogram, automated, and manual differential WBC count [CBC]).
 
If the patient has Medicare as his primary carrier, check the local medical review policies (LMRPs) set by your local carrier. LMRPs, however, say that separate charges made by physicians, independent laboratories or hospital laboratories for drawing or collecting specimens should be allowed whether the specimens are referred to physicians or other laboratories for testing. Most Medicare carriers allow for only one collection fee for each patient encounter, regardless of the number of specimens drawn. When a series of specimens is required to complete a single test such as glucose tolerance (82951-82952), the series is treated as a single encounter.
 
The correct lab draw code for Medicare is G0001. Code 36415 will be denied as noncovered because only G0001 is recognized. You may not bill Medicare for tests performed in an outside lab because Medicare will not allow you to bill for a service you did not provide. You may report these to Medicare if you indicate on the claim that the specimen was sent to an outside lab. Document the fee you paid to the lab.  
 
If the patient has Medicaid as the primary carrier, ask  your local office for guidelines. In Texas, Medicaid will not pay for a venipuncture, 36415 or G0001. This service is a bundled service. They will, however, pay for the lab handling, 99000.
 
If the patient has coverage under a managed-care plan,  check the contract. Some will allow a venipuncture to be done in the office. Many bundle it with the office visit, and some deny the procedure as "noncovered" ( in which case you may bill the patient for the venipuncture). Others require that the patient be sent to that plan's designated lab for the draw as well as the tests.