Wiki Requesting venipucture and modifier 25 advice

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Brandy0618

Brandy0618

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I am still really confused with a ton of information that I have on whether or not I am to attach a modifier 25 to venipuncture or not? (36415) Some coders say yes, some say no. Most always in our office (pediatrics) the children don't come in with intentions of a blood draw. Its only during the appointment if our Dr states it is necessary to rule out concerns that the blood draw is complete. I welcome any advice. Thank you!!:)
 
No Modifier required

This is from American Academy of Pediatrics

"Therefore, effective immediately and for all claims submitted after January 1, 2013, AAP urges its members to append modifier 25 to the preventive medicine service code (99381-99395) when it is reported in conjunction with any immunization administration service (90460-90461; 90471-90474).

A modifier 25 should also be appended to other non-preventive medicine E/M services (eg, 99201-99215) when reported in conjunction with immunization administration -- but only when the E/M service is significant and separately identifiable."

CPT 36415 venipuncture is not included in this statement. In my many years of coding and billing, I've never had to add modifier 25 to EM code with venipuncture.

Hope this helps!

Rose Squiabro, CPC, CPMA, CEMC
 
Usually modifier 25 is mandatory only with therapeutic procedures and with few diagnostic procedures..... CPT 36415 is just a venipuncture, it is not a therapeutic or diagnostic, so modifier 25 is not applicable to E&M when coded with 36415.

Thanks,
Sivakumar CPC, CPC-H
 
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