Basics of CPT code 36415 (Venipuncture)
Venipuncture is surgical puncture of a vein especially for the withdrawal of blood or for intravenous medication. There are several different methods for the collection of a blood sample. The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold. Cpt code 36415 is used for reporting venipunture in medical coding.
Definitions of CPT code 36415 & 36416
A needle is inserted into the skin over a vein to puncture the blood vessel and withdraw blood for venous collection in CPT code 36415. For reporting CPT code 36416, a prick is made into the finger, heel, or ear and capillary blood that pools at the puncture site is collected in a pipette. In either case, the blood is used for diagnostic study and no catheter is placed.
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen
S9529 Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient.
CPT includes codes to report venipuncture requiring a physician’s skill, which are chosen according to the patient’s age and, for those patients younger than 3 years old, by the vein accessed:
- 36400 Venipuncture, younger than age 3 years, necessitating physician skill, not to be used for routine venipuncture; femoral or jugular vein
- 36405 scalp vein
- 36406 other vein
- 36410 Venipuncture, age 3 years or older, necessitating physician skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)
The collection of the specimen by venipuncture is not considered an integral part of the laboratory procedure performed. If both the collection of the specimen(s) by venipuncture and the laboratory procedure(s) are performed, then it would be appropriate to report a code for the collection of the specimen(s) in addition to the appropriate code(s) from the 80000 series for the laboratory procedure(s) performed
Moreover, code descriptions for CPT 36415 and HCPCS level- ll S9529 are similar except for the place of service (POS). HCPCS Level- II code S9529 is typically for single homebound, nursing home, or skilled nursing facility patients.
As per CPT assistant, CPT Code 36415 should be reported for the venipuncture to obtain a blood specimen using either a butterfly or another type of blood collection apparatus.It would not be appropriate to report CPT code 36000, Introduction of needle or intracatheter, vein, because code 36000 involves not only placement of a needle or intracatheter into a vein but is specifically used when a venous injection procedure is being performed. If the venipuncture requires physician’s skill, then a code from the 36400-36410 series may be appropriate.
Report a single unit of 36415, per episode of care, regardless of how many times venipuncture is performed. This instruction comes from the 2018 National Correct Coding Initiative (NCCI) Policy Manual, Chapter V: Respiratory, Cardiovascular, Hemic and Lymphatic Systems CPT Codes 30000-39999.
The venipuncture is billed only once per day, per encounter, for each type of specimen, regardless of the number of specimens drawn. When a series of specimens are required to complete a single test (e.g. glucose tolerance test), the series would be treated as a single visit.
CPT code 36415 describes collection of venous blood by venipuncture. Each unit of service (UOS) of this code includes all collections of venous blood by venipuncture during a single episode of care regardless of the number of times venipuncture is performed to collect venous blood specimens. Two or more collections of venous blood by venipuncture during the same episode of care are not reportable as additional UOS [Units of Service].
The coder/ biller must submit a claim with an appropriate POS as per CMS guidelines to get an appropriate reimbursement.
The current procedure terminology for CPT 36415 does not require a medical qualification. The refusal of a claim for payment of CO-97, M15, M144 or N70 must be adjusted if the procedure or service is not paid.
CPT 36415 does not require a modifier to override the edit.
Routine venipuncture or the collection of specimens in an ASC (Ambulatory Surgical Center) is a subset part of the primary procedure.
CPT Code 99000 is intended to reflect the work involved in the preparation of a specimen prior to sending it to the laboratory. Typical work involved in this preparation may include centrifuging a specimen, separating serum, labeling tubes, packing the specimens for transport, filling out lab forms and supplying necessary insurance information and other documentation.
Example
If a physician performs a venipuncture in the office to obtain a blood specimen, code 36415, Routine venipuncture or finger/heel/ear stick for collection of specimen(s), should be reported. In addition, code 99000 should be reported when the physician’s office centrifuges the specimen, separates the serum and labels, and packages the specimens for transport to the laboratory
MUE- Venipuncture (CPT code 36415)
MUE Value for code 36415 =2
Link to check MUE ; https://www.cgsmedicare.com/medicare_dynamic/j15/mue/mue_tool.aspx
Note: An MUE for a HCPCS/CPT code is the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.
Before billing the cpt code 36415 check below points;
- No claim edit triggered unless units are in excess of 2
- If only one episode of care, can only bill unit of 1
- Documentation would have to support two separate episodes of care based on CMS’
definition to report 2 units. – Easy claims data mining and request for supporting documentation - Consider observation patients and outpatients staying past midnight
CMS/NCCI definition states the one unit includes all blood collections provided during an episode of care.