Summary & Overview
CPT 36425: Venous Incision for Blood Collection or Injection
CPT code 36425 represents a minor surgical venous access procedure in which an incision is made to access a vein for blood collection or medication injection in patients older than one year. This code captures a targeted clinical intervention used when standard percutaneous venipuncture is not appropriate or feasible, and it is relevant across acute and outpatient care settings. Nationally, accurate use of this code affects billing consistency, quality reporting, and proper classification of invasive vascular procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for when 36425 is appropriate, common sites of service where it is performed, and the operational considerations that influence billing and coding accuracy. The publication also presents benchmarking and payer coverage patterns where available, summarizes related policy and documentation expectations, and highlights typical procedural use cases to aid coders and administrators in determining appropriate code selection.
The content is intended for a national audience and focuses on clarifying the code’s clinical meaning, typical service settings, and the types of insights payers and providers use when classifying and reimbursing this procedure. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 36425 describes a procedure in which the provider makes an incision in the skin to access a vein and then collects a blood sample or injects medication in a patient older than one year. This procedure is an invasive vascular access technique performed by clinicians to obtain blood specimens or administer therapies when peripheral venous access by percutaneous puncture is not feasible.
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Service type: Minor surgical vascular access for blood collection or medication administration.
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Typical site of service: Ambulatory surgical centers, hospital outpatient departments, emergency departments, and other acute care settings where procedural incision and venous access are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or older child presenting to an outpatient clinic, emergency department, or inpatient unit requiring venous access for blood collection or medication administration. The provider performs a small skin incision or venotomy to cannulate an accessible peripheral vein (commonly the antecubital or dorsal hand veins) when routine venipuncture is difficult due to obesity, edema, scarring, or vascular disease. The clinical workflow includes patient identification and consent, aseptic preparation, local anesthesia if indicated, making a brief incision to expose the vein, collecting blood samples or injecting medication, achieving hemostasis, dressing the site, and documenting procedure details including reason, technique, site, and any complications. Example scenarios include obtaining diagnostic blood cultures in a patient with difficult venous access, administering a single-dose IV bolus medication when IV catheter placement is not feasible, or obtaining timed laboratory specimens when peripheral venipuncture attempts have failed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Professional component | Use when reporting the physician or nonfacility practitioner’s professional service if separate from technical facility billing. |
22 |