Oncology & Hematology Coding Alert

Question: Our oncology surgeon did a therapeutic phlebotomy in a patient with polycythemia. Should I code it as a venipuncture, i.e. with codes 36400-36425?

Colorado Subscriber

Answer: You do not report codes 36400 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein) – 36425 (Venipuncture, cutdown; age 1 or over) for therapeutic phlebotomy. These codes are for venipuncture your physician performs in the office, and you’ll code it based upon the method used to collect the blood sample.

For a therapeutic phlebotomy, report code 99195 (Phlebotomy, therapeutic [separate procedure]).

What is therapeutic phlebotomy? A therapeutic phlebotomy is similar to a blood donation except that it is done as a treatment approach. When done for polycythemia, it helps to reduce the blood cell mass.

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, personnel to perform the service and necessary equipment.

Do not forget the diagnosis codes: For polycythemia, you’ll default to D75.1 (Secondary polycythemia).