Primary Care Coding Alert

Question: I recently used 99195 (Phlebotomy, therapeutic (separate procedure)) for a routine blood draw, but it was denied. What code should I report when I resubmit?

New Jersey Subscriber

Answer: For routine blood draws, you will typically use 36415 (Collection of venous blood by venipuncture). Here’s why.

The most significant difference between 99195 and 36415 lies in the distinction between the terms “phlebotomy” and “venipuncture.” We often use these words interchangeably. Technically though, venipuncture is a subset of phlebotomy, which refers to the collection of blood by one of several methods, some of which are not venipuncture. Another distinction rests with the inclusion of the word “therapeutic” in the descriptor for 99195. A routine blood draw is not done for therapeutic purposes. You’d use 99195, for example, when the practitioner performs a separate therapeutic procedure to withdraw blood to reduce the number of excess blood cells in a patient with polycythemia vera. The practitioner is collecting blood in this instance, similar to a routine draw, but for a very different reason, which makes a big difference to payers and the patient’s health history.

Note: If the routine venipuncture is being done on a patient younger than age 3 years and necessitates the skill of a physician or other qualified healthcare professional, consider using one of the venipuncture codes among 36400-36406. If the venipuncture requires cutdown, use either 36420 or 36425, depending on the age of the patient.