tci ED Coding & Reimbursement Alert - 2020 Issue Q4

Reader Questions: Know Complexity With Venipuncture Codes

Question: Aside from the age restrictions, what is the difference between venipuncture codes 36400-36410, 36420-36425, and 36415? New York Subscriber Answer: According to the CPT® guidelines, 36400-36410 can only be administered by a “physician or other qualified health care professional,” such as a nurse practitioner or physician assistant, and not by clinical staff such as a registered nurse (RN) or a licensed practical nurse (LPN). That’s because services such as 36400-36406 (Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional …) and 36410 (Venipuncture, age 3...

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