Pathology/Lab Coding Alert

Question: A pulmonologist ordered arterial blood gas analysis to be performed during complex pulmonary stress exercise. Should the lab bill 36600?

Oregon Subscriber

Answer: No, the lab should not bill 36600 (Arterial puncture, withdrawal of blood for diagnosis) for arterial blood gas analysis.

The lab should bill for the lab test that measures the desired blood gases ordered by the pulmonologist. Depending on what the doctor orders, you might bill a code such as:

• 82803 — Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation) or
• 82805 — Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation) with O2 saturation, by direct measurement, except pulse oximetry.

Understand 36600: The physician who performs the arterial puncture to extract the blood should bill 36600, as it is a physician service paid on the Medicare physician fee schedule.

Arterial puncture is a far more complicated procedure than routine venipuncture and must be performed by a physician. The service is bundled in some situations, such as critical care. In a critical care situation, the physician should bill the appropriate critical care code such as 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) instead of 36600.