Primary Care Coding Alert

Question: Which code should I use for routine venipuncture of a Medicare patient? My carrier is denying G0001 on 2005 claims.

Oklahoma Subscriber  Answer: HCPCS 2005 deleted G0001 (Routine venipuncture for collection of specimen[s]). You should use 36415 (Collection of venous blood by venipuncture) instead of G0001.
 
The American Academy of Family Physicians requested G0001's deletion when CPT first revised the venipuncture codes in 2003. Prior to the revisions, CPT lumped routine venipuncture and sticks (finger, heel, ear stick) under one code: 36415. CPT 2003 created 36416 (Collection of capillary blood specimen [e.g., finger, heel, ear stick]) specifically for capillary blood specimen collection and revised 36415 for venipuncture.

Code 36415's revisions made it synonymous with G0001, meaning G0001 duplicated 36415.
 
HCPCS typically deletes temporary G codes when CPT creates a code that describes the same service. But, in this case, HCPCS left G0001, so you had to use G0001 for Medicare and 36415 for all other insurers.
 
Watch out: Even though you should now report routine venipuncture with 36415 regardless of payer, insurers may bundle the CPT venipuncture code into the claim's E/M service.
 
- Answers to You Be the Coder and Reader Questions provided by Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis.; Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a healthcare consulting firm based in Landsdale, Pa.; and Lynn Sallings, CPC, compliance officer for Family Medical Center, Area Health Education Center-Northwest in Fayetteville, Ark.