How To Use CPT Code 36405

CPT 36405 describes the procedure of venipuncture for patients who are younger than three years old and require the skill of a physician or other qualified healthcare professional. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36405?

CPT 36405 can be used to describe the venipuncture procedure performed on patients who are younger than three years old and require the expertise of a physician or other qualified healthcare professional. This code is specifically used for venipuncture in the scalp area and should not be used for routine venipuncture procedures.

2. Official Description

The official description of CPT code 36405 is: ‘Venipuncture, younger than age 3 years, necessitating the skill of a physician or other qualified health care professional, not to be used for routine venipuncture; scalp vein.’

3. Procedure

1. The healthcare professional positions the patient appropriately to ensure normal blood flow and prepares the puncture site by cleaning the skin.
2. The provider then parts and clips the hair to expose the scalp area and secures it with adhesive tapes.
3. Using a needle attached to a flexible tube, the healthcare professional inserts the needle into the vein of the scalp at an angle of approximately 20° or less parallel to the vein.
4. Thumb pressure is applied to the skin a couple of inches below the puncture site to steady the vein during the procedure.
5. The healthcare professional confirms the correct placement of the needle by checking for blood flow.
6. If necessary, the needle is inserted further, taking care to avoid piercing the posterior wall of the vein.
7. Once the desired procedure, such as blood collection or drug infusion, is completed, the healthcare professional withdraws the needle and applies pressure to stop any bleeding.

4. Qualifying circumstances

CPT 36405 is used for patients who are younger than three years old and require the skill of a physician or other qualified healthcare professional for venipuncture in the scalp area. This code should not be used for routine venipuncture procedures. The scalp refers to the skin and soft tissue layer that covers the top of the head.

5. When to use CPT code 36405

CPT code 36405 should be used when performing venipuncture on patients who are younger than three years old and require the expertise of a physician or other qualified healthcare professional. It is important to note that this code should not be used for routine venipuncture procedures. Instead, codes 36415 or S9529 should be used for routine venipuncture in different settings.

6. Documentation requirements

To support a claim for CPT 36405, the healthcare professional must document the following information:

• Patient’s age and the need for venipuncture in the scalp area
• Date and time of the procedure
• Details of the procedure, including the use of a needle attached to a flexible tube
• Confirmation of correct needle placement and blood flow
• Procedure performed, such as blood collection or drug infusion
• Any complications or additional measures taken, such as applying pressure to stop bleeding
• Signature of the physician or qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 36405, ensure that the procedure is performed by a physician or other qualified healthcare professional and is specifically for venipuncture in the scalp area for patients younger than three years old. It is important to note that this code should not be reported for routine venipuncture procedures. Additional tips for reporting CPT 36405 may include considering the use of modifier TC or modifier 26, depending on the location and professional component of the procedure.

8. Historical information

CPT 36405 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several changes to the code, including updates in 2004, 2007, and 2013.

9. Examples

1. A physician performing venipuncture in the scalp area of a two-year-old patient to collect a blood sample for laboratory testing.
2. A qualified healthcare professional inserting a needle into the scalp vein of a one-year-old patient to administer medication intravenously.
3. A physician performing venipuncture in the scalp area of a three-month-old infant to collect a blood sample for diagnostic purposes.
4. A qualified healthcare professional performing venipuncture in the scalp vein of a two-year-old patient to administer a vaccine.
5. A physician inserting a needle into the scalp vein of a six-month-old patient to collect a blood sample for genetic testing.
6. A qualified healthcare professional performing venipuncture in the scalp area of a one-year-old patient to administer a therapeutic drug.
7. A physician performing venipuncture in the scalp vein of a three-year-old patient to collect a blood sample for allergy testing.
8. A qualified healthcare professional inserting a needle into the scalp vein of a two-year-old patient to administer intravenous fluids.
9. A physician performing venipuncture in the scalp area of a four-month-old infant to collect a blood sample for monitoring medication levels.
10. A qualified healthcare professional performing venipuncture in the scalp vein of a one-year-old patient to administer a contrast agent for imaging studies.