Oncology & Hematology Coding Alert

Question: We reported 99195 (Phlebotomy, therapeutic [separate procedure]) for a blood sample we took for a lab test during a follow-up appointment. The payer denied the claim. Isn't taking a blood sample a phlebotomy?


California Subscriber
Answer: You may hear clinicians refer to taking a blood sample as a phlebotomy, but you shouldn't report therapeutic code 99195 for a blood draw you took for tests during a follow-up.

Your CPT manual offers a family of codes for venipunctures for obtaining blood specimens, starting with 36400 (Venipuncture, under age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein) and ending with 36425 (Venipuncture, cutdown; age 1 or over).
 
Example: Report the blood draw with 36415 (Collection of venous blood by venipuncture) and the appropriate E/M service, such as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Coders report 36415 most frequently, but you should choose the code that best describes the procedure the provider performed.

Remember: Your payer will decide whether it will reimburse you for a blood draw.

If your practice also performed the lab work, you should report it with a code such as 85025 (Blood count; complete [CBC], automated [Hgb, Hct, RBC, WBC and platelet count] and automated differential WBC count) or 85027 (... complete [CBC], automated [Hgb, Hct, RBC, WBC, and platelet count]).

Code 99195: CPT designed code 99195 for therapeutic encounters in which the physician addresses a specific blood-related problem, such as polycythemia vera (ICD-9 code 238.4) to reduce the hematocrit and red blood cell mass.