Can't Find Your Way Through the Heart?

Follow this map for on-target selective catheter coding

Navigating through the twists and turns of arterial catheterization coding can be daunting if you don't know where each vessel is located. Take a peek at this handy chart and create a clear mental picture.

Remember Artery Pattern With Quick Trick
Because the CPT codes for selective catheter placement are defined by branches - also known as "orders" - you should think of the collective group of arteries as a tree. Each time the trunk splits off, you have a new branch. While the trunk itself isn't selective, each branch you enter counts as a new order. Here's an example to illustrate:
The physician places a selective catheter into the right internal and external carotid artery via the right common femoral artery. He begins by placing the catheter into the right common femoral and moving it up in the aorta. This step does not count as selective, just as regular catheter placement, says Shannon Boyer, RHIA, CIC, president of SMB Coding Inc. in Orlando, Fla.
 
From there, the first artery you'll enter is the brachiocephalic, or innominate, artery (two names for the same vessel), which you would report as first order with 36215 (Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family).
Decide Second or Third Branch for Carotids
After the brachiocephalic portion, the artery splits in two branches - the right subclavian and the right common carotid. These branches are both second order, so you should code them using 36216 (... initial second order thoracic or brachiocephalic branch, within a vascular family), Boyer says. Because the doctor is headed toward the internal and external carotids, he'll have to go through the right common carotid. Both the internal and external carotids are third-order arteries because they are separate branches. You'll code them as 36217 (... initial third order or more selective thoracic or brachiocephalic branch, within a vascular family).
You should code according to the farthest extent that the physician entered the catheter, so let's suppose he entered both the internal and external carotids. You'd code this with 36217 and +36218 (... additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family).
Separate Sides, Separate Procedure
Let's take this example a step further: If you had also selected the right subclavian artery - a second-order vessel - you'd use 36218 again because the artery is an additional second or third order, Boyer says. Then suppose the doctor pulled the catheter back into the aorta and placed it in the left common carotid artery. The left common carotid is a first- order artery, but because it's [...]

- Published on 2003-09-11