General Surgery Coding Alert

Question: Our surgeon attempted percutaneous venipuncture for a 2 months old infant weighing 7.8 pound, but was unable to obtain access to the femoral vein, so proceeded to a cutdown. Can we bill both the venipuncture and the cutdown, and should we use modifier 63?

Washington Subscriber

Answer: You should code this case as 36420 (Venipuncture, cutdown; younger than age 1 year). The code describes a procedure where the provider makes an open incision to obtain access to a vein, usually because the patient is so young that the physician cannot obtain intravenous access with a percutaneous stick into the peripheral vein.

No modifier: CPT^® guidelines instruct you not to report modifier 63 (Procedure performed on infants less than 4 kg) with 36420.

CPT^® Appendix A states, “Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients. This circumstance may be reported by adding modifier 63 to the procedure number.” But the 36420 text note says not to use modifier 63, because the code valuation already accounts for the increased complexity of the procedure.

Stand alone: You should not additionally report 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) for the attempted percutaneous venipuncture that the physician attempted but did not complete. You should never separately report an unsuccessful procedure that the surgeon converts to another procedure.