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 [...]