Pediatric Coding Alert

Question: What is the difference between 36400 and 36410? Is it necessary to do a femoral or jugular vein draw to charge 36400?

Wisconsin Subscriber

Answer: The patient's age, the vein, and the physician's role all give clues to the appropriate venipuncture code.

A physician must draw blood from the femoral or jugular vein in a patient younger than age 3 to support 36400 (Venipuncture, younger than age 3 years, necessitating physician's skill, not to be used for routine venipuncture; femoral or jugular vein). The descriptor has a semicolon preceding "femoral or jugular vein," which means the venipuncture is from one of these veins.

In 36410 (Venipuncture, age 3 years or older, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes [not to be used for routine venipuncture]), the venipuncture's difficulty, such as small veins in a patient 3 years of age or older, makes the physician performing the office blood draw medically necessary. The code does not specify the vein for collection.

Code 36400 describes a technically difficult procedure. For instance, a child has already had numerous phlebotomies of the arms and legs. "Because of the exceptional need for the laboratory evaluation and the condition of the old phlebotomy sites in the arms and legs, the physician elects to draw blood from the femoral or jugular vein," according to the clinical example in CPT 2004 Changes: An Insider's View.

More: Additional codes for venipuncture necessitating the physician's skill in children less than 3 years include 36405 (... scalp vein) and 36406 (... other vein).

-- Information for to You Be the Coder and Reader Questions provided by Peter A. Hollman, MD, medical director for Blue Cross Blue Shield of Rhode Island at the AMA CPT conference; Robin Linker, CPC, CPC-H, CCS-P, MCS-P, CPC-P, RMC, CHC, chief executive officer of Robin Linker & Associates Inc. in Aurora, Colo.; and Richard Tuck, MD, FAAP, a pediatrician with PrimeCare of Southeastern Ohio in Zaneville.