Cracking the IR Code: Catheterization Coding Basics

Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC Medical Coding Leave a Comment

Cracking the IR Code: Catheterization Coding Basics

It is widely acknowledged that interventional radiology is one of the most complex medical coding specialties to master. There are many reasons why interventional radiology coding is so very challenging, but one of the main reasons is that many codes may be required to accurately capture all of the steps of a vascular procedure. To achieve success with interventional radiology coding, one of the first areas a coder must master is deciphering catherization coding rules to correctly assign non-selective and selective catheterization codes.

Non‐Selective vs. Selective Catheterization

When coding interventional radiology procedures, catheterization codes are classified as non-selective or selective.

Nonselective catheter placement indicates the catheter is placed directly into an artery and the catheter is not advanced further into a branch vessel or is advanced only into the aorta from any approach.

CPT codes 36140, 36200, 36160, 36100 are examples of non-selective catheterization codes.

Selective catheter placement indicates that the catheter is advanced through the vessel punctured beyond the aorta into a vascular family, or in the case of an ipsilateral antegrade procedure, the catheter is advanced into a network of vessels that arise from the access site. Selective catheterizations are classified as either first, second or third order and beyond.

CPT codes 36215 (first order), 36216 (second order), 36217 (third order), +36218 (additional second, third or beyond) are selective catheterization codes assigned when performed above the diaphragm.

CPT codes 36245 (first order), 36246 (second order), 36247 (third order) +36248 (additional second, third or beyond) are selective catheterization codes assigned when performed below the diaphragm.

Catheterization Coding Rules

Always code selective over non‐selective catheterization. When both a non-selective catheterization and a selective catheterization are performed through the same point of access, only the code for the selective catheterization is assigned. Non-selective catheterization is bundled with selective catheterization.

Example: Access is gained at the right common femoral artery. The physician advances the catheter to the aorta (non-selective), injects contrast and provides an interpretation for an abdominal aortogram, the catheter is placed into the left subclavian artery (selective) for injection and imaging.

 

Catheterization Code: 36215

Explanation: The catheterization of the aorta (36200) is non‐selective and the catheterization of the left subclavian artery (36215) is selective. Once the catheter is advanced through the aorta into another vessel, the non‐selective catheterization (36200) is bundled into the selective catheterization (36215) and only the code for selective catheterization is assigned.

 

Code to the highest order selectivity. Catheterization codes are assigned based on the furthest catheter placements achieved within a vascular family. A third order catheterization is coded over a second order catheterization, and a second order catheterization is coded over a first order catheterization.

Example: Arterial System

Example: Access is gained at the right common femoral artery. The physician advances the catheter to the aorta (non-selective), injects contrast and provides an interpretation for an abdominal aortogram, then advances the catheter into celiac artery (selective) for injection and imaging, followed by injection and imaging of both the common hepatic and the left hepatic arteries.

 

Catheterization Code: 36247

Explanation: The catheterization of the aorta (36200) is non‐selective and the catheterization of the celiac artery (36245) is selective. Once the catheter is advanced through the aorta into another vessel, the non‐selective catheterization (36200) is bundled into the selective catheterization code. The celiac is a first order vessel (36245), however once the catheter is advanced into the common hepatic, a second order vessel (36246), the 36245 is no longer assigned because it is bundled into 36246. Additionally, once the catheter is advanced into the left hepatic artery, a third order vessel (36247), the 36246 is no longer assigned because it is bundled into 36247.

 

Code each vascular family separately. If more than one vascular family is catheterized, each vascular family is reported separately.

Example: Access is gained at the right common femoral artery. The physician advances the catheter into the celiac artery for injection and imaging, followed by catheterization of the superior mesenteric artery and inferior mesenteric artery for injection and imaging.

 

Catheterization Codes: 36245, 36245-59, 36245-59

Explanation: This example demonstrates selective catheterization of multiple vascular families. Three separate vascular families were catheterized, therefore there will be three catheterization codes assigned for this case. Catheterization of the celiac artery is a first order catheterization (36245), catheterization of the superior mesenteric is a first order catheterization (36245) and catheterization of the inferior mesenteric (36245) is a first order catheterization. Each vessel marks a different vascular family. Since each catheterization was performed in a separate vascular family, 36245 will be reported for each first order vessel catheterized. Modifier ‐59 (or other required NCCI modifier) will need to be appended to the second and third 36245. Use of an NCCI modifier indicates these were separate vascular families.

 

Code each vascular family to the highest order of selectivity. It is important that the physician documents the final catheter placement within each vascular family so the appropriate first, second or third order catheterization codes can be assigned, as well as the add on catheterization codes.

Example: Access is gained at the right common femoral artery. The physician advances the catheter to the celiac for injection and imaging, then the common hepatic for injection and imaging. Finally, he advances the catheter into the right hepatic artery for injection and imaging.

 

Catheterization Code: 36247

Explanation: Only one family was catheterized, the celiac family, so only one first, second or third order catheterization code can be assigned. The celiac and the common hepatic were catheterized on the path to the final destination, the right hepatic. The correct code for the right hepatic is 36247. The lesser order catheterizations celiac (36245) and common hepatic (36246) are bundled into the 36247 for the right hepatic, the highest order catheterization.

 

Use add-on codes for additional branches within the same vascular family. If the physician catheterizes an additional branch in the same family, add on codes +36218 (above the diaphragm) or +36248 (below the diaphragm) should be assigned

Example: Access is gained at the left common femoral artery. The catheter is advanced into the left thyrocervical trunk for injection and imaging. Next, the catheter is advanced into the left costocervical trunk for injection and imaging.

 

Catheterization Codes: 36216, 36218

Explanation: Only one family was catheterized, the subclavian family, therefore only one first, second or third order catheterization code can be assigned. The first vessel catheterized was the thyrocervical trunk, a second order vessel off of the left subclavian (36216). The catheter was pulled back and advanced into the costocervical trunk also a second order vessel off of the left subclavian. Since 36216 has already been reported for the thyrocervical trunk, it may not be reported again for the same family, therefore add on code +36218 is reported for catheterization of the costocervical trunk. Code +36218 is reported for additional second or third order branches in the same family.

 

References: Buck, Stacie L.  Cracking the IR Code: Your Comprehensive Guide to Mastering Interventional Radiology Coding. RadRx, 2021 ed.

 

About Stacie L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC

Stacie is President & Senior Consultant at RadRx in Stuart, FL. Stacie is a nationally sought out speaker who provides consulting services to providers of diagnostic and interventional radiology services. Stacie has 29 years’ experience in healthcare, 21 of which she has spent working in radiology. She is the author of the book Cracking the IR Code: Your Comprehensive Guide to Mastering Interventional Radiology Coding and creator of Mastering Interventional Radiology & Cardiology Online Education Program.

 

For additional information on Stacie’s interventional radiology online training course, please visit: https://radrx.com/education/online-education/

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