Primary Care Coding Alert

Question: When a family physician performs venipunctures in the office, which is the proper code 36410 or 36415?

Alabama Subscriber

Answer: When the venipuncture requires a physician's skill, you should use 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture). Some patients have veins that nurses or other personnel are unable to access, requiring the "physician's skill." This type of venipuncture is considered "nonroutine." Only the physician may report 36410.

When a nurse or other staff member besides a physician performs a venipuncture report 36415* (Routine venipuncture or finger/heel/ear stick for collection of specimen [s]). This type of venipuncture is "routine." If a physician performs a venipuncture that does not require a physician's skill, you should use 36415. Although Medicare covers venipunctures, it does not reimburse for finger/heel or ear sticks. When billing for a routine venipuncture for a Medicare patient, use G0001 (Routine venipuncture for collection of specimen[s]).