Revenue Cycle Insider

Question: What are the differences between venipuncture codes 36400-36410, 36420-36425, and 36415 other than the age of the patient?

AAPC Forum Participant

Answer: According to the CPT^® guidelines, only a physician or other qualified healthcare professional can perform venipuncture described by 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) through 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)). This means that these codes are applicable when the service is performed by a surgeon or another qualified individual in your practice like a nurse practitioner (NP) or physician assistant (PA). However, these codes should not be used for venipuncture performed by clinical staff like a registered nurse (RN) or a licensed practical nurse (LPN).

This is why: The services described by 36400 through 36410 are more complex than the routine venipuncture service described by 36415 (Collection of venous blood by venipuncture). That’s why a physician or other qualified healthcare professional must perform the procedures.

The next distinction between the codes is related to anatomy, but it also correlates with age. Codes 36400 through 36406 (… other vein) 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 group. Use 36400 specifically for a blood draw from the femoral or jugular vein, 36405 (… scalp vein) from the scalp vein, and 36406 from veins other than the ones listed.

Then, there are 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. During this procedure, the practitioner needs to reach a vein for the purpose of drawing blood or administering medication, which involves making an incision in the skin rather than just a puncture.

Therapeutic: Although all these codes can be used for the collection of blood samples for diagnostic reasons, only one code, 36410, can be used for therapeutic purposes to manage specific blood diseases, as indicated in its descriptor. This also clarifies the additional wording in the code’s descriptor, advising against the use of 36410 for “routine venipunctures.”

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC