# IV Protocol CPT code 36410



## wess0808 (Dec 29, 2011)

Hi,
I have a question.....Please help 
We currently have a protocol at our hospital for IV sticks.  After 3 sticks by a nurse, they call the physician, if the physician cannot get the stick, they call in a CRNA .  The CRNA will always get the stick and they bill 36410. After reading the CPT code description, it states the procedure requires the physicians expertise in placing the IV. Our CRNA's are much more skilled in placing lines since they do it every day for our OR patient's,etc. Should we be billing CPT code 36410 if performed by a CRNA?   Any feedback would be greatly appreciated.
Thank you
Jean


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## mitchellde (Dec 29, 2011)

no, it is specifically for when the physician performs the venipuncture.


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## sspain (Dec 30, 2011)

I have a slightly different view, and the ultimate answer may be different for your various carriers.  If your CRNA's are independently credentialled as providers, then I think you could bill under their NPI for the service.  More likely though, is that they are supervised by a physician, and I think you could bill the service under the supervising physicians NPI.  Either way,  I would recommend that you contact each payer and ask for guidance, as this is a very common occurrence in the inpatient setting.  For the physician who attempted and failed, you could likely bill for the service with a -52 modifier, but I would also recommend you obtain and follow your carrier specific guidelines for the reduced services modifier.


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## donnajrichmond (Dec 30, 2011)

wess0808 said:


> Hi,
> I have a question.....Please help
> We currently have a protocol at our hospital for IV sticks.  After 3 sticks by a nurse, they call the physician, if the physician cannot get the stick, they call in a CRNA .  The CRNA will always get the stick and they bill 36410. After reading the CPT code description, it states the procedure requires the physicians expertise in placing the IV. Our CRNA's are much more skilled in placing lines since they do it every day for our OR patient's,etc. Should we be billing CPT code 36410 if performed by a CRNA?   Any feedback would be greatly appreciated.
> Thank you
> Jean


  who is the crna employed by?


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## mitchellde (Dec 30, 2011)

sspain said:


> I have a slightly different view, and the ultimate answer may be different for your various carriers.  If your CRNA's are independently credentialled as providers, then I think you could bill under their NPI for the service.  More likely though, is that they are supervised by a physician, and I think you could bill the service under the supervising physicians NPI.  Either way,  I would recommend that you contact each payer and ask for guidance, as this is a very common occurrence in the inpatient setting.  For the physician who attempted and failed, you could likely bill for the service with a -52 modifier, but I would also recommend you obtain and follow your carrier specific guidelines for the reduced services modifier.



I don't think so when the code specifically states necessitate physician skill.  I do not think you can have a non physician use this code but they can use the 36415.


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## sspain (Dec 30, 2011)

You will see that for virtually every other service in the CPT book it does not specify "necessitating physicians skill".  I think the reason this phraseology is used here is to make it clear that this code is NOT to be used for routine phlebotomy by non providers (ie nurses, aides, and phlebotomists).  In the example, the physician has failed and so he is calling on an even more expertly skilled provider, whom I think could be compensated.  Again, this is a common occurence and should be easily clarified by the payer.


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## mitchellde (Dec 30, 2011)

sspain said:


> You will see that for virtually every other service in the CPT book it does not specify "necessitating physicians skill".  I think the reason this phraseology is used here is to make it clear that this code is NOT to be used for routine phlebotomy by non providers (ie nurses, aides, and phlebotomists).  In the example, the physician has failed and so he is calling on an even more expertly skilled provider, whom I think could be compensated.  Again, this is a common occurence and should be easily clarified by the payer.



exactly and since this one does specify this I would not feel comfortable using it for a non physician even though he had tried and failed.  Just my opinion


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