How To Use CPT Code 36406

CPT 36406 describes the procedure of venipuncture for patients who are younger than three years old and requires 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 36406?

CPT 36406 is used to describe the venipuncture procedure for patients who are younger than three years old. This code is specifically for cases where the skill of a physician or other qualified healthcare professional is necessary. It should not be used for routine venipuncture procedures.

2. Official Description

The official description of CPT code 36406 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; other vein.’

3. Procedure

1. The healthcare professional positions the patient appropriately to ensure normal blood flow.
2. Using a needle attached to a flexible tube, the provider inserts the needle into a vein other than the scalp, jugular, or carotid.
3. Thumb pressure is applied to the skin a couple of inches below the puncture site to steady the vein during the procedure.
4. The provider carefully inserts the needle, ensuring it does not pierce the posterior wall of the vein.
5. After collecting blood or infusing a drug, the provider withdraws the needle and applies pressure to stop any bleeding.

4. Qualifying circumstances

CPT 36406 is used when the venipuncture procedure is performed on patients who are younger than three years old and requires the skill of a physician or other qualified healthcare professional. It should not be used for routine venipuncture procedures. The procedure must be performed on a vein other than the scalp, jugular, or carotid.

5. When to use CPT code 36406

CPT code 36406 should be used when performing a venipuncture procedure on patients who are younger than three years old and when the skill of a physician or other qualified healthcare professional is necessary. It should not be used for routine venipuncture procedures.

6. Documentation requirements

To support a claim for CPT 36406, the healthcare professional must document the following information:

• Patient’s age (must be younger than three years old)
• Reason for the venipuncture procedure
• Specific vein used for the procedure
• Date and time of the procedure
• Any complications or additional procedures performed
• Signature of the physician or qualified healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 36406, ensure that the procedure is performed on a patient who is younger than three years old and that the skill of a physician or other qualified healthcare professional is necessary. Do not report this code for routine venipuncture procedures. Instead, report the appropriate codes for routine venipuncture procedures.

8. Historical information

CPT 36406 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code since its addition, including updates to the description and qualifying circumstances.

9. Examples

1. A physician performing a venipuncture procedure on a two-year-old patient to collect a blood sample for testing.
2. A qualified healthcare professional using CPT 36406 to perform a venipuncture on a one-year-old patient for intravenous drug administration.
3. A physician performing a venipuncture procedure on a three-month-old infant to collect a blood sample for diagnostic purposes.
4. A qualified healthcare professional using CPT 36406 to perform a venipuncture on a two-year-old patient for therapeutic purposes.
5. A physician performing a venipuncture procedure on a six-month-old baby to collect a blood sample for monitoring a medical condition.
6. A qualified healthcare professional using CPT 36406 to perform a venipuncture on a two-year-old patient for blood transfusion.
7. A physician performing a venipuncture procedure on a one-year-old patient to collect a blood sample for genetic testing.
8. A qualified healthcare professional using CPT 36406 to perform a venipuncture on a three-year-old patient for intravenous fluid administration.
9. A physician performing a venipuncture procedure on a nine-month-old infant to collect a blood sample for allergy testing.
10. A qualified healthcare professional using CPT 36406 to perform a venipuncture on a two-year-old patient for therapeutic drug monitoring.