CPT code venipuncture - 36415 and 36416 -Billing Tips - Not seperately paid

Procedure Codes and Definitions

36415 Collection of venous blood by venipuncture  - Fee schedule amount $3.10

36416 Collection of capillary blood specimen (eg, finger, heel, ear stick)  Fee schedule amount  $3.1

P96l5 - Catheterization for collection of specimen(s)

General Definition

Venipuncture or phlebotomy is the puncture of a vein with a needle to withdraw blood. Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures, and is sometimes referred to as a “blood draw.”

Venipuncture is the process of withdrawing a sample of blood for the purpose of analysis or testing. There are several different methods for the collection of a blood sample. The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold


Collection of a capillary blood specimen (36416) or of venous blood from an existing access line or by venipuncture that does not require a physician’s skill or a cutdown is considered “routine venipuncture

Venipuncture

Venipuncture is the process of withdrawing a sample of blood for the purpose of analysis or testing. There are several different methods for the collection of a blood sample. The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold. Please refer to the coding section of this policy for the procedure code most applicable to the method of blood withdrawal.


This policy addresses the Health Plan’s reimbursement policies pertaining to clinical laboratory and related laboratory services (e.g., venipuncture and the handling and conveyance of the specimen to the laboratory) for professional provider claims submitted on a Form CMS-1500, whether performed in a provider’s office, a hospital laboratory, or an independent laboratory

When blood is drawn to be sent to a reference lab, use code 36415 for the venipuncture. HCPCS Code G0001 was deleted in 2005. The most appropriate current code for G0001 is 36415 and the current fee for this is $3.00.



• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:

80048 82247 82728 83655 84450 85651
80050 82306 82784 83891 84460 85652
80051 82310 82785 84132 84550 86003
80053 82378 82947 84144 84702 86038
80055 82465 82948 84146 84703 86304
80061 82533 82950 84153 85007 86308
80069 82550 82951 84402 85013 86592
80074 82565 82962 84403 85014 86677
80076 82575 83001 84432 85018 86703
82040 82607 83036 84436 85025 86706
82105 82627 83516 84439 85027 86787
82150 82670 83540 84443 85610


• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:

80061 82947 83036 85014 85027
82247 82948 83655 85018 85610
82465 82962 85013 85025


Billing and Coding Guidelines

A. Routine Venipuncture/Capillary Blood Collection

Routine venipuncture CPT codes 36415 and S9529 and capillary blood collection code 36416, are eligible for reimbursement when billed with an E/M and/or a laboratory service. Unless an additional routine venipuncture/capillary blood collection is clinically necessary, this service is only eligible for reimbursement once per member, per provider, per date of service.

CPT 36415 is only eligible to be billed once, even when multiple specimens are drawn or when multiple sites are accessed in order to obtain an adequate specimen size for the desired test(s). ODS does not allow separate reimbursement for CPT 36415 (venipuncture) when billed in conjunction with a blood or serum lab procedure performed on the same day and billed by the same provider (procedure codes in the 80048 - 89399 range). 36415 will be denied as a subset to the lab test procedure.

If some of the blood and/or serum lab procedures are performed by the provider and others are sent to an outside lab, CPT 36415 is not eligible for separate  eimbursement.


Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures. The work of obtaining the specimen sample is an essential part of performing the test. Reimbursement for the venipuncture is included in the reimbursement for the lab test procedure
code.

Venipuncture is only eligible to be billed once, even when multiple specimens are drawn or when multiple sites are accessed in order to obtain adequate specimen size for the desired test(s).

PacificSource does not allow separate reimbursement for venipuncture when billed in conjunction with the blood or  serum lab procedure performed on the same day and billed by the same provider will be denied as a subset to the lab test procedure

Modifier 90 (reference laboratory) will not bypass the subset edit. The outside laboratory that is actually performing the test will need to bill ODS directly in order for 36415 to be separately reimbursable to the provider performing the venipuncture to obtain the specimen for the outside laboratory.

The use of modifier 59 with 36415 when blood/serum lab tests are also billed is not a valid use of the modifier. The venipuncture is not a separate procedure in this situation. ODS does allow separate reimbursement for CPT 36415 when the only other lab services billed for that date by that provider are for specimens not obtained by venipuncture (e.g. urinalysis)

UnitedHealthcare considers venipuncture code S9529 (Routine venipuncture for collection of Specimen(s), single homebound, nursing home, or skilled nursing facility patient) a nonreimbursable service. The description for S9529 focuses on place of service for a service that is more precisely represented by CPT code 36415 and reported with the appropriate CMS place of service code.


Codes 36415 and 36416  are only covered as Preventive when done for a preventive lab procedure that requires a blood draw.

FCHP will not reimburse separately for 36415 (collection of venous blood by venipuncture) and/or 36416 (collection of capillary blood specimen i.e., finger, heel, ear stick) when billed along with an E&M office visit (99201-05; 99211-15) or preventative medicine service (99381-87; 99391-97) or office-based lab CPT codes (i.e. CLIA waived tests).

• FCHP does reimburse 36415 when it is the sole service provided.

• FCHP does reimburse 36416 when it is the sole service provided.

The following procedures/services are included in reporting critical care when performed during the critical period and, therefore, should not be coded separately. Please see CPT for specific code definitions. 36000, 36410, 36415, 36540, 36600, 43752, 71010, 71015, 71020, 91105, 92953, 93561, 93562, 94002, 94003, 94004, 94660, 94662, 94760, 94761, 94762, 99090.

CPT code 36415 for Collection of venous blood by venipuncture is now payable by Medicare, but code 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick) remains as not payable by Medicare as a separate service.


CPT code 36416

CPT 36416 is designated as a status B code (bundled and never separately reimbursed) on the Physician Fee Schedule RBRVU file. ODS clinical edits will deny CPT code 36416 with explanation code WGO (Service/supply is considered incidental and no separate payment can  be made. Payment is always bundled into a related service), whether 36416 is billed with another code or as the sole service for that date. This edit is not eligible for a modifier bypass.


Venous blood collection by venipuncture and capillary blood Specimen collection (CPT codes 36415 and 36416) will be reimbursed once per physician or other health care professional per patient per date of service. When CPT code 36416 is submitted with CPT code 36415, CPT code 36415 is the only venipuncture code considered eligible for reimbursement. No modifier overrides will exempt CPT code 36416 from bundling into CPT code 36415.

When bill with office visit CPT code use Modifier 25 with E & M CPT code like 99211.

Multiple Venipuncture on Same day would be reimbursed for one unit.


STEPS TO FOLLOW IN PERFORMING A VENIPUNCTURE

1. If blood does not flow immediately, several steps can be taken to obtain the specimen.

a. Change the position of the needle. The needle may have penetrated the vein too far. In that case, pull back gently. If the needle has not penetrated far enough, gently push it in. Use the free index finger to feel above the puncture to locate the vein. Do not probe through tissue. This is painful and damaging. It may be just necessary to change the needle angle slightly. The bevel of the needle may be up against the vein wall and may be obstructing the blood flow.

b. Sometimes the Vacutainer tubes will lose vacuum and will not fill. In this case, try another tube.

c. Sometimes the tourniquet is so tight that it is obstructing blood flow. Loosen the tourniquet to see if this helps.

2. If blood still does not flow trying another site may be necessary, preferably in the other arm. Never stick a patient more than twice. After two unsuccessful tries, call someone else more experienced. By this time, the phlebotomist and the patient have lost confidence.

NOTE: You should never attempt an arterial stick or a stick to a foot vein without an order from the physician. An arterial stick is very traumatic to the patient and can result in serious, permanent damage to the circulation in that limb and to the nerves in that area. (Refer to the arterial puncture procedure for more details concerning the risks involved in arterial punctures.) Sticking a foot vein also involves risk, especially to a diabetic patient or any patient with poor circulation, due to risk of infection. If you cannot obtain blood from the arm by way of venipuncture (maximum of two attempts), ask another phlebotomist to try. Only after we have exhausted all other means, should an arterial puncture or a foot-puncture be attempted, and then only with a physician’s order.

3. As soon as the blood starts to flow, loosen the tourniquet. Remember, if the tourniquet is left on too long, the blood in this area will have an increased concentration of cells (hemoconcentration) and test results may be affected. If the veins are very small, leave the tourniquet on until the collection is complete. Always remove the tourniquet before removing the needle. The patient may open his fist as soon as the blood flow starts.

4. Apply clean, dry gauze to the site and gently withdraw the needle. Immediately lock the safety shield in place over the needle.

5. Apply gentle pressure to the point of the puncture until the bleeding has stopped. The patient should keep arm straight and/or elevate it above the heart. After the bleeding stops, apply a pressure bandage to the site, unless the patient refuses. Instruct the patient to leave the bandage on for at least 15 minutes. (NOTE: The patient may apply pressure if able.)

6. Dispose of needle and needle holder by way of Bio-Hazard sharp container.

7. PROPERLY LABEL TUBES FROM THE ARMBAND. Computer labels may be used after comparing with the armband. All tubes must be labeled with the patient’s name, account number, date collected, time collected, and collector’s initials. Additionally, any tube collected for any Blood Bank test, must have the hospital number handwritten from the armband, unless the patient identification system label is used.

8. Clean the area. Never leave anything in a patient’s room unless isolation techniques are warranted. Remove gloves after each patient contact. Wash hands before leaving the patient’s room. Do not wear gloves while going from room to room.

PATIENTS WITH IVs

a. Blood may be drawn in an arm with an I.V. only if drawn below the I.V.

b. If the patient has an I.V., one alternative to an impossible venipuncture is to request the nurse in charge to disconnect the I.V., wait at least 2 minutes, and draw blood from the needle already in the vein. Just remember that at least 3 ml should be discarded before the samples are collected. This avoids dilution and contamination of the sample with the I.V. fluid. Alternately, venipuncture can be performed in this arm after the 2 minute wait.

c. Always have the nurse disconnect the I.V. Phlebotomists should never turn off or on the patient’s I.V.

d. Do not put a tourniquet on above an I.V. without checking with the nurse.

e. The phlebotomist should always check with the nurse or the lab supervisor/charge tech if there are any questions.

Note: Refer to the procedure, “Adverse Reactions to Phlebotomy” for additional information. If the patient develops a hematoma, excel bleeding, tingling in the arm, or any other adverse reaction, this should be reported to the patient’s nurse and documented. Inform your supervisor so that a Risk Management report may be initiated.




Reimbursement Guide for Routine Venipuncture and the Collection of Blood Specimen - BCBS

A. Routine Venipuncture/Capillary Blood Collection

Routine venipuncture procedure codes 36415 and S9529 and capillary blood collection code 36416, are eligible for reimbursement when billed with an E/M and/or a laboratory service. Unless an
additional routine venipuncture/capillary blood collection is clinically necessary, this service is only
eligible for reimbursement once per member, per provider, per date of service.
B. Collection of Blood Specimen

The Health Plan follows the 2013 procedure coding guidelines which state that procedure 36591-36592 should not be reported “…in conjunction with other services except a laboratory service.1 ” Therefore, these codes are only eligible for separate reimbursement when billed with a laboratory service.

IV. Handling, Conveyance of Specimen, and/or Travel Allowance

The Health Plan considers the handling, conveyance, and/or travel allowance for the pick up of a laboratory specimen, to be included in a provider’s management of a patient. Therefore codes 99000, 99001, P9603, and P9604 are not eligible for separate reimbursement. See also our Bundled Services and Supplies Reimbursement Policy.

CODING

Codes eligible for separate reimbursement when billed with a laboratory service:

36415: collection of venous blood by venipuncture

36416: collection of capillary blood specimen (e.g., finger, heel, ear stick)

S9529: routine venipuncture for collection of specimen (s), single home bound, nursing home, or skilled nursing facility patient

36591: collection of blood specimen from a completely implantable venous access device

36592: collection of blood specimen using established central or peripheral venous catheter

Codes not eligible for separate reimbursement:

99000: handling and/or conveyance of specimen for transfer from the physician's office to a laboratory

99001: handling and/or conveyance of specimen for transfer from the patient in other than a  physician's office to a laboratory

P9603: Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually travelled

P9604: Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge


Routine Venipuncture and/or Collection of Specimens

Venipuncture or phlebotomy is the puncture of a vein with a needle or an IV catheter to withdraw blood. Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures, and is sometimes referred to as a “blood draw.” The work of obtaining the specimen sample is an essential part of performing the test. Reimbursement for the venipuncture is included in the reimbursement for the lab test procedure code.

Collection of capillary blood specimen or a venous blood from an existing line or by venipuncture that does not require a physician’s skill or a cutdown is considered “routine venipuncture.”

Professional and Clinical Laboratory Services: with E & M codes

Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures. The work of obtaining the specimen sample is an essential part of performing the test. Reimbursement for the venipuncture is included in the reimbursement for the lab test procedure code.

Venipuncture is only eligible to be billed once, even when multiple specimens are drawn or when multiple sites are accessed in order to obtain adequate specimen size for the desired test(s).

Insurance does not allow separate reimbursement for venipuncture when billed in conjunction with the blood or serum lab procedure performed on the same day and billed by the same provider will be denied as a subset to the lab test procedure.

If some of the blood and/or serum lab procedures are performed by provider and others are sent to an outside lab, venipuncture is not eligible for separate reimbursement.

The use of modifier 59 with venipuncture when blood/serum lab tests are also billed is not a valid use of the modifier. The venipuncture is not a separate procedure in this situation.

Insurance does allow separate reimbursement for venipuncture when the only other lab services billed for that date by that provider are for specimens not obtained by venipuncture (e.g. urinalysis).

Collection of a capillary blood specimen is designated as a status B code (bundled and never separately reimbursed) on  the Physician Fee Schedule RBRVU file. Insurance clinical edits will deny a collection of a capillary blood specimen whether it is billed with another code or as the sole service for that date. This edit is not eligible for a modifier bypass.

For Inpatient Hospital Services:

A maximum of one collection fee (any procedure code) is allowed per specimen type (venous blood, arterial blood) per date of service, per CMS policy. Specimen collections out of an existing line (arterial line, CVP line, port, etc.) are not separately reimbursable. 11.13 Lab Handling Codes

The following procedure has been updated to follow Insurance claims editing software:

Lab Handling Codes

• 36415—Collection of venous blood by venipuncture.

Our claims editing system may deny as unbundled when billed with any E&M, lab or other procedure codes.

• 36416—Collection of capillary blood specimen. Our claims editing system may deny as unbundled when billed with any E&M, lab or other  procedure codes.

• 99000—Handling and/or conveyance of specimen for transfer from physician’s office to a lab.*

• 99001—Handling and/or conveyance of specimen for transfer from the patient in other than a physicians office to a laboratory.*

• 99002—Handling, conveyance, and/or any other service in connection with implementation of an order involving devices (e.g. designing, fitting, packaging, handling, delivering, or mailing) when devices such as orthotics, protectives, or prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician.*

*These codes (99000, 99001, and 99002) will deny as unbundled when billed with an E&M code.

2 comments:

Anonymous said...

Does Virginia medicaid pay for 85018 when billed with 99383.

Anonymous said...

what codes can I use to be reimburse the highest with code 36415?

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