Pulmonology Coding Alert

Question: When the pulmonologist collects blood samples and sends them to an outside lab for analysis, we've been getting denials. How can we prevent this?

Maryland Subscriber

Answer: Your denials may have to do with your diagnosis coding or lack thereof.

When the pulmonologist procures blood samples for off-site lab work, you should report 36415 (Collection of venous blood by venipuncture) with the most appropriate and specific ICD-9 codes you can apply--- don't expect the lab to provide the codes for your claim; that should be up to your physician.

Some offices erroneously wait for lab results to assign diagnosis codes for blood tests. But because physicians can sometimes report services related to diagnostic lab tests, physicians need to provide the reason for the test.

The documentation in the medical record provides that reason and can include the signs and symptoms that prompted the tests.

Note: According to Medicare Program Memorandum: AB-01-144, the laboratory cannot assign a diagnosis code unless a physician interprets the results of the test.

Keep in mind that the lab will report the lab test codes (80048-89356) for the specimen analysis, so you should only bill for the collection of the samples.