Pathology/Lab Coding Alert

Question: When our lab provides a phlebotomist to draw blood, can we code separately for the phlebotomy service for routine lab tests using a code such as 99195?


Oregon Subscriber

Answer: Although you can separately code for the phlebotomy service (blood draw) for routine lab tests when your lab personnel draws the blood, you should not use 99195 (Phlebotomy, therapeutic [separate procedure]). CPT designed this code for therapeutic encounters in which the physician addresses a specific blood-related problem, such as polycythemia vera (238.4) to reduce the hematocrit and red blood cell mass.

CPT provides other codes to describe withdrawing blood to obtain a test specimen, starting with 36400 (Venipuncture, younger than 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).

Avoid this: You should not use the physician codes such as 36400, 36405 (- scalp vein), 36406 (- other vein) or 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]) for your phlebotomist's service. 

The most common codes you would use for your phlebotomist's service is 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]).

Old way: Because labs had to report blood draws to Medicare using G0001 (Routine venipuncture for collection of specimen[s]) until 2005, you might still hear people referring to that code. You should no longer use G0001, however, because Medicare now accepts 36415 for venipuncture service. Medicare will not pay separately for a capillary blood draw (36416).

Remember: Not every payer will reimburse you for blood draws. Some payers consider the service bundled with the costs associated with the lab test.