Pulmonology Coding Alert

Question: We saw a patient for a blood draw and sent it to an outside lab for testing. The doctor saw the patient that morning. Can we report the E/M service and the blood draw? Which code should we report for the blood draw since we didn't do the testing?

Indiana Subscriber

Answer: Once you've determined that a blood draw is not actually therapeutic phlebotomy (99195), you need to turn to the venipuncture codes -- and, in some cases, the lab testing codes.

If you're sending your patients to an outside lab for both the blood draw and testing, you cannot report any blood-draw codes. But if your practitioners collect the blood, you have two options for coding the service, depending on where the blood goes next.

Outside: If the blood specimen that your practice collects goes to an outside lab for testing, report 36415 (Collection of venous blood by venipuncture) for the blood draw, and then choose the appropriate-level E/M service code for the visit.

Most Medicare carriers allow for one collection fee for each patient encounter, regardless of the number of specimens drawn. When a single test, such as a comprehensive metabolic panel (80053), requires a series of specimens, treat the collections as a single encounter. You would report 36415 once per encounter, and the laboratory is responsible for billing the different testing codes.

However: Check with individual payers on whether to use 36415 when it is part of a larger E/M visit. Some carriers may not allow you to bill it separately. Instead, they claim that you should bundle the blood draw as part of the E/M service.

Inside: If your practice has its own lab to perform blood tests, you can report the test along with the venipuncture. The lab must have Clinical Laboratory Improvement Amendments (CLIA) certification and can process only appropriate-level tests.

Example: An office staff member draws a Medicare patient's blood and performs a complete blood count (CBC) with platelet and white blood cell (WBC) counts. Along with 36415, report 85025 (Complete blood count).

-- Answers to You Be the Coder and Reader Questions were answered/ reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.