Pathology/Lab Coding Alert

Question: Can the lab bill for blood collection? Which code should we use?


Ohio Subscriber


Answer: Some payers cover a separate blood collection fee, and some don't, so you'll need to check with individual payers. Medicare will pay for blood collection by venipuncture, but not fingerstick, while some payers cover both. Still others consider the blood-collection service bundled with the lab test.

Use these codes to report blood collection by venipuncture or fingerstick: 36415 (Collection of venous blood by venipuncture) or 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]). Prior to Jan. 1, you had to report venipuncture to Medicare using G0001 (Routine venipuncture for collection of specimen[s]) - but no more. Medicare now accepts 36416 for that service, according to CMS Change Request 3526.

If you bill Medicare for venipunctures, make sure you also bill private payers for the procedure on non-Medicare patients. That way you don't appear to be billing Medicare differently, which could lead to suspicions of fraud and abuse.

CPT provides other codes for specialized blood draws such as arterial puncture, but many payers recognize these only as professional services. Medicare, for example, may pay for these codes under the Physician Fee Schedule when the physician performs the draw.

The 36400 family of codes describes venous blood draws from a small child. These codes are 36400 (Venipuncture, under age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein), 36405 (... scalp vein) or 36406 (... other vein).

Code 36540 (Collection of blood specimen from a completely implantable venous access device) describes withdrawal of venous blood through a catheter.  Many payers consider this service bundled with other catheter or lab codes. In any event, do not report 36540 with either 36415 or 36416, according to CPT direction.

For certain tests such as blood gases, physicians may perform an arterial blood draw, which represents a far more complicated procedure than routine venipuncture. You should report this service with 36600 (Arterial puncture, withdrawal of blood for diagnosis) rather than a venipuncture code. When a physician provides arterial puncture, Medicare pays for the procedure at nearly 10 times the rate of a routine venipuncture.

 - Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctor's Anatomic Pathology, an independent pathology laboratory in Jonesboro, Ark.