Oncology & Hematology Coding Alert

Question: The oncologist took a blood sample from a patient with skin cancer during a follow-up visit. We reported 99195 (Phlebotomy, therapeutic [separate procedure]) and were denied. Why? Isn't this procedure a phlebotomy?


Arkansas Subscriber

Answer: While the procedure you described is often referred to as a phlebotomy, you should not use the therapeutic phlebotomy code when the doctor draws blood during a follow-up visit. On your claim, you should have done one of two things:

Option 1: You could have reported 36415 (Collection of venous blood by venipuncture) for the blood draw and the appropriate-level evaluation and management service code for the visit.
 
If the physician performed an E/M service and collected blood from the patient, look for additional information on the claim that makes the encounter at least a level-two (and sometimes a level-five) service.
 
Let's say the oncologist met with the skin cancer patient, drew blood for analysis and provided level-four E/M service. On the claim, report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M service, and report 36415 for the blood draw.

Option 2: You might report a lab test code, such as: