Cardiology Coding Alert

Tip: Use modifier 59 when reporting lower-order cath with high-order cath

Thanks to complicated coding guidelines, confusion about how to report catheterizations, not reimbursement, is on the rise. Make sure your cath claims sail through extra smooth by avoiding the following pitfalls.

Pitfall 1: You're Confused by 36218, 36248

Don't get caught not fully understanding +36218 (Selective catheter placement, arterial system; additional second-order, third-order, and beyond, thoracic or brachiocephalic branch, within a vascular family [list in addition to code for initial second- or third-order vessel as appropriate]) and +36248 (Selective catheter placement, arterial system; additional second-order, third-order, and beyond, abdominal, pelvic, or lower-extremity artery branch, within a vascular family [list in addition to code for initial second- or third-order vessel as appropriate]).

"You use these codes for additional second-order or higher cath placements within the same vascular family," says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.

For example, if the cardiologist puts the catheter into the right internal carotid and the right vertebral, you should report one with 36217 (Selective catheter placement, arterial system; initial third-order or more selective thoracic or brachiocephalic branch, within a vascular family) and the other with +36218 (additional second order or higher). "Sometimes cardio practices want to report two units of 36217 in this situation, which is overcoding," Miller says.

Rule of thumb: Typically, you should only report one of the catheter placement codes ending with the digit 5, 6 or 7 in each vascular family the cardiologist selectively engages, says Jim Collins, CPC, ACS-CA, CHCC, CEO of the Cardiology Coalition. On the other hand, you can report the codes that end in the digit 8 several times in a given vascular family.

Pitfall 2: Not Coding Selective Cath for Each Vascular Family

You're making a mistake if you're not coding an initial selective cath placement for each vascular family your cardiologist catheterizes. 

For example, if the patient has an accessory left renal artery (that is, he has two renal arteries on the left side), each is a separate vascular family. If you catheterize both, assign two units of 36245 (Selective catheter placement, arterial system ...) or list the code twice, depending on your payer's preference.

Pitfall 3: You Forgot Cath Placement With Intervention

Don't forget to code the catheter placement with the intervention.

For example, if the patient presents for superficial femoral artery (SFA) angioplasty, you need to code the cath placement in the SFA (if it's from a contralateral puncture, then 36247, Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) as well as the angioplasty.

Pitfall 4: You're Only Coding 36200 Once

Did you know you can assign 36200 (Introduction of catheter, aorta) more than once if you place catheters into the aorta from separate accesses (punctures)? 

For example, if the cardiologist punctures both femoral arteries and advances a catheter into the aorta from each side, you should report either 36200-50 (Bilateral procedure), 36200-LT (Left side)/36200-RT (Right side), or two units of 36200, depending on how your payer wants you to report a bilateral procedure.

Pitfall 5: Forgoing the Use of Modifier 59

You should use modifier 59 (Distinct procedural service) whenever you report a lower-order cath placement with a higher-order cath placement, says Pat Gajewski, CPC, a full-time coder at Consultants in Cardiovascular Disease Inc. in Erie, Pa. 

For example, if you catheterize the left and right common carotid arteries, you will report 36216 (Selective catheter placement, arterial system; initial second-order thoracic or brachiocephalic branch, within a vascular family) for the right common carotid (RCC) and 36215 (Selective catheter placement, arterial system; each first- order thoracic or brachiocephalic branch, within a vascular family) for the left common carotid (LCC).

If you don't put modifier 59 on code 36215, your payers will assume that both codes apply to the same vascular family, so they will deny the lower-order code, Miller says.

Important: "Documentation can be your biggest mistake," Gajewski says. "If the cardiologist does not have the information in the report, you can't back your codes up."

Report for Basic Training

Piecing together and implementing the coding and billing rules applicable to peripheral vascular procedures is a monumental task. In addition to properly assigning catheter placement codes, you must also master diagnostic imaging codes, interventional coding conventions and learn how to decipher complex operative reports. 

Make sure to tune into The Coding Institute's peripheral vascular coding boot-camp series (basic training on March 23 and advanced training on April 13) in which Jim Collins will present everything you need to become an expert PV coder in an easy-to-understand, step-by-step fashion.

Visit www.codinginstitute.com to learn about this great opportunity and to enroll in the programs.