icd 10 code for 36415

Full Answer

Is code 36415 covered by Medicare?

We get paid every time on 36415 - a whopping $3, minus 6 cents for sequestration One reason you may not be getting paid is if you are trying to bill 36415 (venipuncture) for an 83036 (fingerstick-type lab) Also, I have heard that some states/Medicare jurisdictions will not pay 36415 for FNPs working off their own NPI

Is 36415 payable by Medicare?

Is CPT CPDE 36415 payable? CPT code 36415 for Collection of venous blood by venipuncture is now payable by Medicare, but code 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick) remains as not payable by Medicare as a separate service.

What is Procedure Code 36415?

ROUTINE VENIPUNCTURE PROCEDURE – CPT 36415

1. Identify the patient. Outpatients are called into the phlebotomy area and asked their name and date of birth. ...
2. Reassure the patient that the minimum amount of blood required for testing will be drawn.
3. Assemble the necessary equipment appropriate to the patient’s physical characteristics.
4. Wash hands and put on gloves.

More items...

Does 36415 require a modifier?

When CPT code 36416 is submitted with CPT code 36415, CPT code 36415 is the only venipuncture code considered eligible for reimbursement. No modifier overrides will exempt CPT code 36416 from bundling into CPT code 36415.

What is the ICD 10 code for routine venipuncture?

Report routine venipuncture with 36415 Collection of venous blood, by venipuncture.

Does Medicare pay for 36415 venipuncture?

If you perform the lab test in your office, you may not bill separately for the “collection of venous blood by venipuncture,” or CPT code 36415, according to the Medicare Claims Processing Manual.

Does CPT code 36415 require a modifier?

Does CPT Code 36415 Need a Modifier? CPT 36415 does not require a modifier to override the edit. Modifier' 59′ is not a valid modifier for venipuncture.

What is CPT code for blood draw?

Guidelines in parenthesis directly under CPT code 36592. Venipuncture or phlebotomy is the puncture of a vein with a needle or an IV catheter to withdraw blood. Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures, and is sometimes referred to as a “blood draw.”

Can 36415 be billed alone?

CPT 36415 is only eligible to be billed once, even when multiple specimens are drawn or when multiple sites are accessed in order to obtain an adequate specimen size for the desired test(s).

Is 36415 a lab code?

36415 is a laboratory service and should be billed as such. Physicians often provide routine venipuncture to patients when ordering a laboratory test to save the patient a trip to the laboratory. This service is reported with CPT® 36415 Collection of venous blood by venipuncture.

How often can 36415 be billed?

only onceCode 36415 is submitted when the provider performs a venipuncture service to collect a blood specimen(s). This code should be billed only once regardless of the number of tests performed from that specimen.

How do you document a blood draw?

The documentation should refer to the written lab order by date and location (e.g., “in the 8/31/16 progress note”) and list the date of venipuncture, time, site, and patient tolerance of the procedure.

Can 99213 and 36415 be billed together?

No 25 modifier s required - Just 99213, 36415. Many payers deny the 36415 as inclusive, but usually only when labs requiring blood work are billed. Just as many pay it every time, too.

Is CPT 36415 covered by Medicaid?

CPT procedure code 36415 (collection of venous blood by venipuncture) was added as a covered service during the 2005 CPT code update. CPT code 36415 replaced G0001 as of January 1, 2005. Providers must use 36415 when billing this service to N.C. Medicaid.

Is venipuncture the same as phlebotomy?

Phlebotomy specifically refers to the single-use needlestick for drawing blood specimens. Whereas venipuncture refers to the broader concept of entering the vein for either drawing blood or administering an IV for an extended period, phlebotomy is limited to blood-sample collection.

What is CPT code 36415?

Physicians who satisfy the specimen collection fee criteria and choose to bill Medicare for the specimen collection must use Current Procedural Terminology (CPT) Code 36415, “Routine venipuncture – Collection of venous blood by venipuncture.

What is the code for handling and/or conveyance of specimen for transfer from the physician’s office to a

Codes not eligible for separate reimbursement: 99000: handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory. 99001: handling and/or conveyance of specimen for transfer from the patient in other than a physician’s office to a laboratory.

Is CPT 36415 eligible for eimbursement?

If some of the blood and/or serum lab procedures are performed by the provider and others are sent to an outside lab, CPT 36415 is not eligible for separate eimbursement. Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures.

Does ODS reimburse CPT 36415?

ODS does not allow separate reimbursement for CPT 36415 (venipuncture) when billed in conjunction with a blood or serum lab procedure performed on the same day and billed by the same provider (procedure codes in the 80048 – 89399 range). 36415 will be denied as a subset to the lab test procedure.

Is S9529 the same as 36415?

Example: Routine blood collection codes 36415, 36416, and S9529 are considered to be the same service; therefore, when all of these codes are reported on the same date of service by the same provider for the same patient, only one of the procedures will be allowed for that date of service.

Is venipuncture reimbursement included in lab test code?

Reimbursement for the venipuncture is included in the reimbursement for the lab test procedure code. Collection of capillary blood specimen or a venous blood from an existing line or by venipuncture that does not require a physician’s skill or a cutdown is considered “routine venipuncture.”.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Article Guidance

The information in this Supplemental Instructions Article (SIA) contains coding or other guidelines for Venipuncture Necessitating Physician’s Skill for Specimen Collection. Coding Guidelines: General Guidelines for claims submitted to Part A or Part B MAC: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

What is CPT code 36410?

CPT code 36410, venipuncture necessitating physician's skill, is defined as a venipuncture for which the skill of a physician is required for diagnostic or therapeutic purposes. Note: 36410 should not to be used for routine venipuncture.

When is CPT 36410 reimbursable?

Payment for CPT 36410 is reimbursable when it is necessary for the venipuncture to actually be performed by a physician; specifically, when it is medically necessary and reasonable to perform the venipuncture. The medical record must contain:

What is the medical record of a venipuncture?

The medical record must contain: Justification that the venipuncture required the skill of a physician and therefore it was reasonable and necessary for venipuncture to be performed by a physician (e.g., MD or DO) or qualified non-physician practitioner (e.g., Nurse Practitioner, Physician's Assistant).

Policy

Aetna considers therapeutic phlebotomy medically necessary for any of the following indications:

Background

Phlebotomy (therapeutic bleeding) is a controlled removal of a large volume (usually a pint or more) of blood. It is used mainly to reduce blood volume, red cell mass and iron stores.

The above policy is based on the following references

Adjarov D, Donov M, Ivanov E, Naidenova E. Phlebotomy treatment in porphyria cutanea tarda combined with beta-thalassaemia. Dermatologica. 1984;169 (4):184-187.