Can you bill 36415 with an office visit?
Asked by: Haskell Hartmann | Last update: July 24, 2025Score: 4.4/5 (41 votes)
Can you bill an office visit for a blood draw?
For example, if a physician instructs a patient to come to the office to have blood drawn for routine labs, the nurse or lab technician should report CPT code 36415 (routine venipuncture) instead of 99211 since an E/M service was not required. The service must be separate from other services performed on the same day.
Can we bill 99211 and 36415 together?
Yes, you can as long as the documentation supports both services.
What are the billing guidelines for 36415?
Use the 36415 CPT code only for routine venipuncture procedures that involve the collection of blood from superficial peripheral veins of the upper and lower extremities. Verify that the blood draw procedure meets the criteria for using the 36415 code, which does not require the skill of a physician.
Can you bill a procedure and office visit together?
Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented. Watch this short video to learn more.
CPT Coding Guidelines — CPT 36415 Replaced with 36410
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Can you bill an E&M with a planned procedure?
In general, E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service.
How much is a CPT code 36415 charge?
According to FAIRHealth® data, depending on the locality where services are performed/zip code, a provider charge for CPT code 36415 can range from $15.00 – $40.00 for this service. Based on ClaimDOC 2023 claims data, the average provider charge for CPT code 36415 is $23.72.
Can you bill 85025 and 36415 together?
So, we can't bill the CPT® 36415 (Venipuncture) with Lab codes (Ex - 80050, 80053, 85025, Ext) under the same DX code.
When should venipuncture be avoided?
Specimens should not be obtained from the arm on the same side as a mastectomy. Avoid areas of hematoma. If an IV is in place, samples may be obtained below but NEVER above the IV site. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft.
What is the difference between 99195 and 36415?
99195 is basically modern day blood letting. it is a theuraputic blood draw most commonly for hemochromatosis with iron overload. 36415 is a blood draw for labs.
How do you document a venipuncture?
Venipuncture at a follow-up visit
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 99211 and 96372 be billed together?
Answer: You cannot ever bill 99211 with 96372. In fact, according to the Correct Coding Initiative (CCI), no modifier will separate the edit bundling these codes together, so there are no circumstances under which they can be reported together.
Can you bill a preventive visit with an office visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
Can you bill for preoperative visit?
Preoperative examinations may be billed by using an appropriate CPT code (e.g., new patient, established patient, or consultation). Preoperative Diagnostic Tests. –Tests performed to determine a patient's perioperative risk and optimize perioperative care.
How do I bill my CPT code 36415?
Multiple venipunctures (36410 or 36415) during the same encounter, to draw blood specimen(s), may only be billed as a single procedure with units of service = 1 (one) regardless of the number of attempts or veins entered. In an ER setting, an "encounter" is considered admission until discharge.
Can 99211 be billed with 36415?
National Correct Coding Initiative (NCCI) version 20.1 includes code pair 36415 Collection of venous blood by venipuncture and 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional.
What is the UHC policy for 36415?
Venipuncture and Specimen Collection
Venous blood collection by venipuncture and capillary blood Specimen collection (CPT codes 36415 and 36416) will be reimbursed once per patient per date of service when reported by the Same Individual Physician or Other QHP.
How do you bill for blood draw?
CPT® 36415, Under Venipuncture and Transfusion Procedures. The Current Procedural Terminology (CPT®) code 36415 as maintained by American Medical Association, is a medical procedural code under the range - Venipuncture and Transfusion Procedures.
Does Aetna pay for 36415?
Effective October 16, 2021
As a result of a recent review, and consistent with industry standards for venipuncture reimbursement, Aetna will deny CPT code 36415 when billed with certain lab codes as incidental.
What is the difference between 36415 and 36000?
Whereas 36415 describes routine venipuncture (to withdraw blood), 36000 Introduction of needle or intracatheter, vein describes routine venous access for introduction of fluids.
Can you bill 99213 and 99396?
In this case, the clinician would report the appropriate preventive service visit (such as 99396) on one line of the claim form, followed by the problem-oriented E/M visit (such as 99213) with modifier 25 appended on the next line.
Can you bill an office visit on the same day as surgery?
A related E/M service provided prior to an unplanned procedure may be billed separately. The procedure must not have been the reason for the visit, and documentation must reflect the medical decision making (MDM) based on the evaluation undertaken at that visit that preceded the recommendation of a specific procedure.
Which services use an E&M code and Cannot be billed separately?
Emergency room E&M CPT codes 99281 thru 99285 and critical care and E&M codes 99291 and 99292 are not separately reimbursable if billed by the same provider for the same recipient and date of service.