ED Coding and Reimbursement Alert

Question: Aside from the age restrictions, what is the difference between venipuncture codes 36400-36410, 36420-36425, and 36415?

New York Subscriber

Answer: According to the CPT^® guidelines, 36400-36410 can only be administered by a “physician or other qualified health care professional,” such as a nurse practitioner or physician assistant, and not by clinical staff such as a registered nurse (RN) or a licensed practical nurse (LPN).

That’s because services such as 36400-36406 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional …) and 36410 (Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional …) are more medically complex than the routine venipuncture service described by 36415 (Collection of venous blood by venipuncture). Thus, the procedures must be performed by a physician or other qualified healthcare professional.

The next difference between the codes is anatomic, though it is also age-related. Codes 36400-36406 are for children under the age of 3, and as veins in children that young are often difficult to locate, each code specifies the location of larger veins that are easier to find in children of that age. So, 36400 is used specifically for a blood draw from the femoral or jugular vein, 36405 from the scalp vein, and 36406 from veins other than the ones listed.

Then, there are two codes — 36420 (Venipuncture, cutdown; younger than age 1 year) and 36425 (…age 1 or over) — that describe a procedure that is also more complex than venipuncture. In this service, the provider has to access a vein to take a blood sample or inject medication into the patient by incising the skin rather than simply puncturing it.

Lastly, while all of these codes can be used to collect blood specimens for diagnostic purposes, only one — 36410 — can be used for therapeutic purposes to treat certain diseases of the blood as its descriptor states. This also explains the other language of the code’s descriptor, which tells you not to use 36410 “for routine venipunctures.”