Laureen: Next stop CPT 36415 replaced with 36410?
Q: Hi, I code CPT 36415 along with labs and have noticed that Medicare and most other carriers deny as global (considered routine & not is not covered) except when billed with physicals. I have also noticed 36415 is not anywhere on CCI edits, however, 36410 is. Is 36410 the preferred venipuncture code lab draws now?
A: So, what I did as I went out to SuperCoder and just kind of pulled in the codes so we can take a look. This one is actually 36410 is an age-specific code, so that’s for age 3 or under – and it is for when the patient is a hard stick; meaning the physician needs to do it. Maybe the normal person doing the blood draw just cannot get it to work, so they call the physician. That’s why 36410 venipuncture age 3 years or older necessitating the skill of a physician or other qualified healthcare professional for diagnostic or therapeutic purposes. That’s why it’s not for the routine venipuncture it’s when they’re hard stick, and it’s age-based as well. 36415 is the collection of venous blood by venipuncture, that’s your routine one.
Medical Coding – CPT 36415 Replaced with 36410 – Video
Then I found a good article in SuperCoder while I was in there. Here’s the link Supercoder, if you have subscription to it. And it’s basically: Our vascular office performs blood draws and analysis for a local hospital. Can we bill for a lab draw in an office setting, and if so, what codes should we use?
And I went to the answer but what struck me is this statement here: Also keep in mind that most Medicare carriers allow one collection fee for each patient encounter, regardless of the number of specimens drawn. If an E/M service is provided and billed, most payers will bundle 36415 into the E/M service.
So, that’s what you’re running into with yours I would suspect, they’re bundling it into the other services that you’re providing. So, it wasn’t necessarily that the one code was to be used over the other. It’s just that 36415 is a routine code and this is bundled in. The 410 you would only use if your patient is 3 years of age or younger and you needed the physician to do it.
Laureen: I’m going to back up to my question here, that I said “age 3 years or younger,” I meant older. I read it wrong. So, it isn’t age-based code so that’s one of the differences; if you had someone that was younger than 3, you would not use 36410, you’d use it for someone older. The key difference between 410 and 415 is needing the physician to come to it because the patient is a hard stick. So, thank you for clarifying that.