Pathology/Lab Coding Alert

Question: What is the difference in the venipuncture codes 36400-36410, 36420-36425, and 36415, and how do these differ from 99195? Can we code these in addition to the lab test if we do the blood draw?

Boston Subscriber

Answer: A primary difference between the codes is who can administer the procedures. CPT^® guidelines specify that the first four codes you list require a “physician or other qualified health care professional.” This does not include a clinical staff member, which CPT^® defines as “a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service.”

On the other hand, 36415 (Collection of venous blood by venipuncture) does not require performance by a physician. Some payers will separately reimburse your lab for routine venipuncture reported with this code in addition to the lab test code.

The other distinctions between 36400-36410 and 36420-36425 have to do with patient age and anatomical location of the blood draw. Labs are unlikely to report these codes.

One more thing: Although you may hear medical staff refer to a blood draw as phlebotomy, there is a big difference in a phlebotomy procedure 99195 (Phlebotomy, therapeutic (separate procedure)) and a routine venipuncture (36415). The phlebotomy involves drawing blood, but the purpose is not to get a specimen for a lab test, but to reduce the patient’s hematocrit volume to treat certain diseases of the blood such as D45 (Polycythemia vera). You can remember that difference by paying attention to the word “therapeutic” in the CPT^® descriptor for 99195.