Oncology & Hematology Coding Alert

Question: I know that when I bill Medicare, certain CPT codes should be submitted as HCPCS codes: For example, 36415* (Routine venipuncture or finger/heel/ ear stick for collection of specimen[s]) is changed to G0001 (Routine venipuncture for collection of specimen[s]). Along the same lines, is there an alternative code for 36540 (Collection of blood specimen from a partially or completely implantable venous access device) when I bill Medicare?

Pennsylvania Subscriber

Answer: This is an excellent question, to which you may receive a number of answers and for good reason. This answer is focused on hospital clinics.

G0001 was a new code in 2002 and one that allows for carrier discretion. If your carrier accepts this code, it is the one you should use to draw a blood specimen from a venipuncture or port. If your carrier does not accept the code, you may bill 36540, but there is no payment value or APC associated with this code.

Another option is to bill for the visit using only 99211 (Office or other outpatient visit ...). This is billable in hospital clinics as well as private practice settings. However, the codes are very different in each setting. Since the inception of APCs, hospitals can bill evaluation and management codes 99211-99215 for nursing and other staff time and effort. In this setting, they are not considered "incident-to" codes. The hospitals were charged with defining each of these codes and using the same definition throughout the outpatient areas.

In private practice settings, 99211 is an incident-to charge used when the patient is seen and evaluated by a nurse who is employed by the physician. Options for billing a blood collection from a port in the private practice setting include 36540 for the procedure; however, better reimbursement will most likely be obtained when you use the E/M code, 99211, for this visit.