Primary Care Coding Alert

Question: What is the difference between venipuncture codes 36410 and 36415?

Florida Subscriber Answer: You should choose the correct venipuncture code based on the professional work required to obtain the specimen. When ancillary staff such as a phlebotomist, lab technician or nurse is unable to obtain the specimen, or perhaps the patient has poor venous access and the physician is needed to do the stick, you should report 36410* (Venipuncture, child over age 3 years or adult, necessitating physicians skill [separate procedure], for diagnostic or therapeutic purposes; not to be used for routine venipuncture). The National Physician Fee Schedule Relative Value File assigns 36410 a total of 0.58 relative value units (RVUs) with a work value of 0.18 RVUs.

On the other hand, when no compelling reason exists for the physician to perform the venipuncture, you should instead use 36415* (Collection of venous blood by venipuncture). Medicare does not assign 36415 any RVUs. But the code usually reimburses at $6.50 compared to $18.40 for 36410, based on predominate payers maximum allowables. This reimbursement comparison reflects that 36410 definitely is paying for the specific work performed by the physician, not by ancillary or nursing staff.