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2025 CPT code 36420

Venipuncture, cutdown; for patients younger than 1 year old.

Follow all applicable CPT coding guidelines related to vascular procedures and venipuncture.Accurate documentation is critical for appropriate reimbursement.

Modifiers may apply depending on circumstances.Consult the CPT manual for a complete list and guidelines on modifier application.For example, modifier 51 may be used if multiple procedures are performed during the same session, and modifier 59 may be used to indicate a distinct procedural service if appropriate.

Medical necessity is established when standard venipuncture techniques are unsuccessful due to the patient's age or venous anatomy, and the need for immediate blood sampling or intravenous therapy outweighs the risks of the cutdown procedure. Proper documentation must support the necessity of this more invasive procedure over standard venipuncture.

The physician is responsible for all aspects of the procedure, including antiseptic preparation of the venipuncture site, making the incision, inserting the needle or catheter into the vein, collecting the blood sample or administering medication, and applying pressure to the site to control bleeding.This requires specialized skill due to the patient's age and the small size of their veins.

IMPORTANT:For patients one year or older, use CPT code 36425.CPT code 36415 is used for routine venipuncture (without cutdown) in older children and adults.Do not use this code for routine venipuncture.

In simple words: This code is for a procedure where a doctor makes a small cut in a baby's skin (younger than one year old) to find a vein and either take a blood sample or give medicine.

This CPT code describes the procedure of venipuncture, specifically a cutdown, performed on patients younger than one year of age.A cutdown involves a surgical incision to access a vein for the purpose of drawing blood or administering medication. The procedure necessitates the physician's skill and precision due to the patient's age and the delicate nature of the veins in young infants.

Example 1: A newborn infant requires blood tests to assess their overall health. A venipuncture cutdown is necessary due to the difficulty in finding suitable veins using standard techniques. , An infant presents with dehydration and requires intravenous fluid administration. A cutdown procedure is performed to facilitate IV access., An infant needs urgent blood work to diagnose a suspected infection, and a cutdown is the most efficient method to obtain the needed blood sample.

Complete medical history, physical examination notes, reason for the procedure (indication), detailed description of the procedure (incision site, vein accessed, volume of blood drawn/medication administered), complications (if any), post-procedure care and patient's response.Detailed documentation justifying medical necessity is crucial, especially for reimbursement purposes.

** This procedure may be performed in various settings depending on the infant's condition and the urgency of the situation.Pre-authorization may be required by some payers.Always refer to payer-specific guidelines for billing and reimbursement.

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