Venipuncture CPT Coding

Posted on 01.13.2016

In today’s blog post, we’ll take a quick look at how you code venipuncture with CPT codes.

CPT code 36415 is used for a collection of venous blood by venipuncture. The 3M CPT lay description of codes 36145 and 36416 is: “A needle is inserted into the skin over a vein to puncture the blood vessel and withdraw blood for venous collection in 36415. In 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.”  This code is frequently used in laboratory settings where blood is drawn for testing.

In the Healthcare Business Monthly January 2016 publication, LuAnn Jenkins reminds us this code requires a physician’s written order. Lack of a valid order will result in a denial due to medically necessity. An advanced beneficiary notice (ABN) may be needed if there is not a covered diagnosis for the procedure. This notice is used to ensure the patient understands their responsibility for payment if the service is not covered.

In CPT Assistant, March 1998 page 10, we learn laboratory CPT codes do not include the collection of the specimen via venipuncture or finger/heel/ear stick. The collection is not considered an integral part of the laboratory procedure performed and is separately reportable. When a venipuncture is performed along with a laboratory procedure, it would be appropriate to code both.

When performed on the same day as an Evaluation/Management code, it is not necessary to append the E/M code with a 25 modifier. CPT Assistant, February 1997, page 9 instructs coders to check with third-party payers for different reporting requirements.