Health Information Management

Q/A: Charging for venipunctures

APCs Insider, August 10, 2012

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Q: I am relatively new to auditing and when I look at my facilities claims I see the venipuncture code (CPT code 36415) assigned on some bills but not on all. All these claims have laboratory services. Can you explain what I need to look for when I do not see the venipuncture code on the claim?

A: CPT code 36415 (collection of venous blood by venipuncture) is used when facility personnel perform a blood draw for the purpose of laboratory testing. 
The CMS Claims Processing Manual, Chapter 16 states:
A specimen collection fee is allowed in circumstances such as drawing a blood sample through venipuncture (i.e., inserting into a vein a needle with syringe or vacutainer to draw the specimen) or collecting a urine sample by catheterization. A specimen collection fee is not allowed for blood samples where the cost of collecting the specimen is minimal (such as a throat culture or a routine capillary puncture for clotting or bleeding time)…… Only one collection fee is allowed for each type of specimen for each patient encounter, regardless of the number of specimens drawn. When a series of specimens is required to complete a single test (e.g., glucose tolerance test), the series is treated as a single encounter.
In some cases, the venipuncture is not charged because nursing personnel will draw blood during the start of an IV line. When the blood specimen is taken during the start of the IV line, the stick is included in the initial service for drug administration and CPT code 36415 is not reported additionally.  
When the blood is drawn from a saline lock, (for example, in the ED), some facilities choose to include this as part of the individual resource mapping criteria. Review your individual facility’s criteria to determine whether this is included in order to capture the resources involved.
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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