36000 vs. 36410
- By Renee Dustman
- In Industry News
- August 1, 2014
- 1 Comment
Have a Coding Quandary? Ask John
Q: Can you explain the difference among venipuncture codes 36000 and 36400-36415?
A: For routine collection of blood samples by venipuncture, use 36415 Collection of venous blood by venipuncture. Codes 36400-36410 differ from 36415 in that they describe venipuncture that requires a physician’s (or other qualified provider’s) skill to perform. The codes distinguish patients by age and, if the patient is younger than 3 years old, by the vein accessed:
36400 Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; femoral or jugular vein
36405 scalp vein
36406 other vein
36410 Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)
As the code descriptors specify, you should not report 36400-36410 for routine venipuncture or, for instance, if the physician draws blood simply because an assistant is not available. Claim 36400-36410 only if documentation supports medical necessity (including any special circumstances) for the physician or other qualified provider to perform the non-routine venipuncture.
Whereas 36415 describes routine venipuncture (to withdraw blood), 36000 Introduction of needle or intracatheter, vein describes routine venous access for introduction of fluids. If the physician or other qualified healthcare provider’s skill is necessary to place a needle for catheter insertion, you may turn to 36400-36410.
Note that National Correct Coding Initiative edits, as well as CPT® guidelines and many payer policies, commonly bundle venous access into surgical, anesthesia, and infusion/injection services because performance of the service requires such access. When intravenous access is a routine component of another procedure, and/or is necessary to accomplish the procedure (e.g., infusion therapy, chemotherapy), do not separately report the venous access.
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If a physician is not available what “other qualified healthcare provider” can be used to perform the procedure? Is a report necessary or is it sufficient to only have proper documentation in the patient’s chart?