Specimen collection codes are used to identify phlebotomy and other services required to obtain body fluids or tissue for laboratory analysis. Medicare and most other payers allow a separate specimen collection charge for drawing or collecting specimens by venipuncture or catheterization whether the specimen is processed on site or referred to another laboratory for analysis. Only one collection fee is allowed for each patient encounter, even when multiple specimens may be collected. When a series of specimens is collected for a single test (for example, glucose tolerance), the series is treated as a single encounter. For non-Medicare claims, the following CPT code is used:
- 36415 ROUTINE VENIPUNCTURE OR FINGER/HEEL/EAR STICK for collection of specimen(s)
For Medicare claims the following HCPCS code is used:
- G0001 ROUTINE VENIPUNCTURE FOR COLLECTION OF SPECIMEN
This code is used to avoid confusion over the inclusion of finger/heel/ear stick specimens in code 36415. Code G0001 must be used for all Medicare venipunctures (and urine collections by catheterization).
Physician laboratories may charge for specimen collection only when (a) it is accepted and prevailing practice among physicians in the locality to make a separate charge for drawing or collecting a specimen, and (b) it is the customary practice of the physician performing such a service to bill separately for specimen collection. In other words, physicians may collect the $3.00 Medicare venipuncture fee only if they also charge other payers for blood draws.
Specimen collection fees are also paid when it is medically necessary for a laboratory technician to draw a specimen from either a nursing home or homebound patient. The technician must personally draw the specimen. When a laboratory performs the specimen collection, it may receive payment both for the draw and the associated travel to obtain the specimen(s) for testing. Payment may be made to the laboratory even if the nursing facility has on-duty personnel qualified to perform the specimen collection. When the nursing home performs the specimen collection, it may receive payment only for the draw. Specimen collection performed by nursing home personnel for patients covered under Medicare Part A is paid for as part of the payment to the facility for its reasonable costs, not on the basis of the specimen collection fee.
The $3.00 Medicare specimen collection fee does not apply to non-routine venipuncture or arterial punctures. Arterial punctures for blood gas testing should be coded as CPT 36600 (arterial puncture, withdrawal of blood for diagnosis). Non-routine venipunctures, such as those common to pediatrics and those performed in atypical vein sites, should be coded using cardiovascular codes, 36400-36410 or 36420-36425. Medicare reimbursement for these procedures is paid from the Physicians’ Medicare Fee Schedule rather than the Medicare Laboratory Fee Schedule.
A code for 24-h urine specimens (81050, volume measurement for timed collection, each) was added in 1993 and is used whenever a volumetric measure of urine is required to report a test result.
Is it acceptable for a client to have the performing lab or technician charge a draw fee to their account and then the client turn around and bill the insurance for venipuncture collect when they did not actually perform the collection.
Patient collected by in office phlebotomist who works for Lab A (not directly for client. Client requests that all draw fees be billed to client at rate of 3.00.
Client then turns around and bills insurance 15.00 venipuncture fee for labs that they did not actually collect making a 12 dollar profit.
Is this fraud and if so, how do you report it?