Cardiology Coding Alert

You're up to speed on reporting percutaneous transluminal coronary angioplasties (PTCA) but a little shaky on the coding when the cardiologist performs an angioplasty in a peripheral (noncoronary) vessel.
 
Sound familiar? If so, learning a few basic guidelines offered by cardiology coding experts will make percutaneous transluminal angioplasties (PTA) in noncoronary vessels seem much less daunting and result in better pay for your provider's services. Learn the PTA Components: Cath Placement + Vessel + S&I Typically, peripheral PTA coding has three basic parts a code for the selective catheter placement, the angioplasty (PTA) code assigned according to the location of the vessel, and the radiological supervision and interpretation (S&I) code for the PTA. Accurate PTA coding depends on including all three, coding experts say.
 
Unlike cardiac catheterization and coronary intervention codes, which are bundled to include catheter placement and S&I services, you should report peripheral procedures, including PTAs, using component (separate) codes, according to the Society of Interventional Radiology's (SIR) CPT user's guide and the American College of Cardiology's (ACC) Guide to CPT Codes 2003. This means you code the angioplasty, the radiological S&I, and the catheterization separately.
 
For peripheral interventions, such as PTAs, you can bill the S&I and catheter placement codes with the angioplasty code for each angioplasty the physician performs, says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CMSCS, a healthcare coding consultant based in Laguna Beach, Calif., and American Academy of Professional Coders (AAPC) National Advisory Board member. Indeed, the CPT description for PTA states that you should report the S&I and the catheter placement in addition to the therapeutic aspect of the procedure or PTA, she says. Catheter Coding: Report Highest Level of Selectivity  PTAs in peripheral vessels require selective catheter placements, so you'll need to understand the fundamentals of selective catheter coding.
 
Selective catheterization indicates that the physician moves the catheter into another part of the arterial or venous system, beyond the initial puncture/access site (such as from a left common femoral access catheter movement to the right renal artery or common iliac), according to the SIR's manual and ACC's coding guide. You choose the correct selective catheterization code depending on "how many bifurcations" the physician must  guide the catheter through, in one direction or another, "before it reaches its most distal or final destination," the ACC's guide says.
 
You should use a code in the 36215-36218 range for catheter placement in the carotids, head/neck or brachiocephalic vascular family and 36245-36248 for catheterization of the abdominal, pelvic or lower-extremity vessels. Remember: Report codes according to the highest-level vessel selectively catheterized in each vascular family. Do not [...]