Coding for Blood Collection From an Established Arterial Catheter

Wisconsin Physicians Service (WPS) has been asked about the proper coding and billing for the service of drawing blood from an arterial catheter. The 2009 CPT Code Book states (page 175, Professional Edition) "for blood collection from an established arterial catheter, use 37799." This CPT code is defined as "Unlisted procedure, vascular surgery." All "unlisted procedure" codes are manually reviewed and evaluated by Medicare contractors.

One could strongly argue that this blood draw service is analogous to CPT 36591 (collection of blood specimen from a completely implantable venous access device) or CPT 36592 (collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified). In fact, the above instructions "for blood collection from an established arterial catheter, use 37799" is found directly under CPT 36592 in the 2009 CPT Code Book.

However, both CPT 36591 and 36592 are listed by the Centers for Medicare & Medicaid Services (CMS) in the 2009 Medicare Physician Fee Schedule Database as "T" status. By CMS national requirements, "T" status codes are "only paid when there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made."

There is no "incident to" billing allowed by national Medicare regulations in a hospital setting. Thus, the only allowable place of service would be in an office. However, there are very few arterial lines used in a true outpatient setting.

In summary, CPT 37799 for the purpose of blood collection from an established arterial catheter cannot be paid in an inpatient setting (e.g. POS 21). Similarly an outpatient hospital setting (POS 22), or emergency room-hospital (POS 23) would also not be appropriate for billing this service since the arterial catheter blood drawing in these three locations would be performed by ancillary staff, and not the physician. If CPT 37799 were billed for this purpose, it will be denied as "not a payable service in this POS."

If this service were done in a physician's office (POS 11) and NO OTHER SERVICES PAYABLE UNDER THE PHYSICIAN FEE SCHEDULE BILLED ON THE SAME DATE BY THE SAME PROVIDER were billed, THEN it could be paid similar to a "T" status CPT code. However, this would be a very rare service.

Stephen D. Boren MD
Medical Director Medicare B Illinois, Michigan, Minnesota

Page Last Updated: Friday, 11-Nov-2011 12:28:46 CST