Practice Management Alert

If You're Not Reporting Venipuncture, You're Poking a Hole in Reimbursement

Payment for blood draw services can really add up over time, yet venipuncture remains one of the most commonly sacrificed sources of revenue among providers.

The problem may be that some billers find it difficult to select the appropriate code for a blood draw. Different rules apply for Medicare and for private payers, but never fear - you can choose the right code every time by following these two simple steps:

1. Determine if the patient is a Medicare beneficiary. If you are billing Medicare for your office lab's services, you have only one code available for blood collection: G0001 (Routine venipuncture for collection of specimen[s]). Law mandates that Medicare cover venipuncture but does not require coverage for collection of a capillary blood specimen (such as a finger or heel stick), says Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla.

If your office performs a finger stick or other capillary collection on a Medicare patient, the service is simply not billable, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

2. Identify whether the blood collection was from a vein or capillary. There are only two major codes to choose from when you bill blood collection services to a private payer: 36415 (Collection of venous blood by venipuncture) and 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]). Selecting the right code is as simple as knowing the source of the collected specimen. Always report the appropriate blood collection code along with any lab test codes, Dettwyler says.