How To Use CPT Code 99195

CPT 99195 is a therapeutic phlebotomy procedure used to remove venous blood from a patient to reduce the number of red blood cells or treat high levels of iron or potassium in the blood. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99195.

1. What is CPT 99195?

CPT 99195 is a medical procedure code that represents therapeutic phlebotomy. It is used when a healthcare provider needs to remove venous blood from a patient to reduce the number of red blood cells or treat high levels of iron or potassium in the blood. This procedure is similar to a blood donation and may require fluid infusions to replace the removed fluid.

2. 99195 CPT code description

The official description of CPT code 99195 is: “Phlebotomy, therapeutic (separate procedure)”.

3. Procedure

The 99195 procedure involves the following steps:

1. The patient is appropriately prepped for the procedure.
2. The healthcare provider inserts an intravenous needle into a vein.
3. Approximately a pint of blood is withdrawn from the patient.
4. An intravenous saline solution may be administered after the phlebotomy to maintain the salt balance in the body.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 99195 services are those who have a medical condition that requires the removal of venous blood to reduce the number of red blood cells or treat high levels of iron or potassium in the blood. Some examples of such conditions include polycythemia vera, hemochromatosis, and hyperkalemia.

5. When to use CPT code 99195

It is appropriate to bill the 99195 CPT code when a healthcare provider performs a therapeutic phlebotomy to treat a patient’s medical condition that requires the removal of venous blood. The procedure should be medically necessary and supported by proper documentation.

6. Documentation requirements

To support a claim for CPT 99195, the following information needs to be documented:

• Patient’s medical history and diagnosis that supports the need for therapeutic phlebotomy.
• Details of the procedure, including the amount of blood withdrawn and any additional treatments administered, such as intravenous saline solution.
• Provider’s notes on the patient’s response to the procedure and any follow-up care or monitoring required.

7. Billing guidelines

When billing for CPT code 99195, it is essential to follow the specific guidelines and rules set by the payer. Some carriers may or may not deny hydration services reported separately along with phlebotomy. It is crucial to check with the carrier to determine how to bill the code. Additionally, ensure that the claim is supported by proper documentation, as mentioned in the documentation requirements section.

8. Historical information

CPT 99195 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 99195

Five similar codes to CPT 99195 and how they differentiate from it are:

• CPT 36415: This code represents a routine venipuncture for blood collection, not a therapeutic phlebotomy.
• CPT 36514: This code is for therapeutic apheresis, which is a more complex procedure that involves the separation and removal of specific blood components.
• CPT 36600: This code is for arterial blood draw, which involves collecting blood from an artery rather than a vein.
• CPT 36400: This code is for venipuncture in infants, not adults or older children requiring therapeutic phlebotomy.
• CPT 36556: This code is for the insertion of a central venous catheter, not a therapeutic phlebotomy procedure.

10. Examples

Here are 10 detailed examples of CPT code 99195 procedures:

1. A patient with polycythemia vera requires therapeutic phlebotomy to reduce the number of red blood cells in their blood.
2. A patient with hemochromatosis needs therapeutic phlebotomy to remove excess iron from their blood.
3. A patient with hyperkalemia undergoes therapeutic phlebotomy to lower their potassium levels.
4. A patient with secondary polycythemia due to chronic obstructive pulmonary disease (COPD) receives therapeutic phlebotomy to alleviate symptoms.
5. A patient with porphyria cutanea tarda undergoes therapeutic phlebotomy to reduce iron levels and improve their skin condition.
6. A patient with erythrocytosis due to testosterone replacement therapy requires therapeutic phlebotomy to reduce red blood cell count.
7. A patient with congestive heart failure and secondary polycythemia receives therapeutic phlebotomy to improve their cardiovascular function.
8. A patient with Budd-Chiari syndrome undergoes therapeutic phlebotomy to alleviate symptoms related to hepatic venous outflow obstruction.
9. A patient with hereditary spherocytosis requires therapeutic phlebotomy to manage their anemia and reduce the risk of complications.
10. A patient with paroxysmal nocturnal hemoglobinuria undergoes therapeutic phlebotomy to manage their symptoms and reduce the risk of thrombosis.