Pediatric Coding Alert

Question: How should we code for a venipuncture? We use CPT 36415 *, but only when sending the specimen to a lab.

Illinois Subscriber

Answer: You are coding correctly: 36415* (routine venipuncture or finger/heel/ear stick for collection of specimen[s]) is the code for work done by the nurse for a venipuncture, even if you send the specimen to a lab. Medicaid often will not pay for a venipuncture, but private payers will although in some cases you will have had to specify this as part of your contract with the insurer. You can bill 36415* along with an office visit, but modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is required on the office visit because the venipuncture is a starred procedure.

According to CPT, the package concept of coding surgical services with a global fee is not applicable with starred procedures. The starred procedure code includes only the surgical procedure (venipuncture or heel/finger stick). To be paid for the starred procedure and the office visit, the office visit needs to include significant identifiable services. You cannot bill 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) along with 36415* if the nurse only collects a blood specimen.