Cardiology Coding Alert

Report 36200, 36100-36160 for nonselective arterial procedures

Our experts have boiled down coding selective and nonselective peripheral vascular procedures to the basics to get you on the road to perfect claims every time.

Acquaint Yourself With These Nonselective Basics

According to Jim Collins, CPC, ACS-CA, CHCC, CEO of the Cardiology Coalition in Matthews, N.C., non-selective procedures involve:

• placing the catheter directly into an artery, or
• manipulating the catheter from an access site toward or into the aorta.

Remember: You're far more likely to see a report that the cardiologist entered a peripheral vessel and manipulated the catheter into either the aorta or the vena cava than that he placed the catheter directly into the aorta or vena cava. The direct translumbar approach is an exception and has its own access code, 36160 (Introduction of needle or intracatheter, aortic, translumbar). This procedure, however, is extremely rare.

Nonselective arterial: You should use intra-arterial and intra-aortic codes 36200 (Introduction of catheter, aorta) and 36100-36160 to report nonselective arterial procedures.

Example: A common example of a nonselective arterial procedure is one that involves a patient with bilateral lower-extremity claudication necessitating a bilateral lower-extremity angiographic study. The doctor will gain access to the arterial system in one of the lower- extremity arteries, move the catheter into the distal portion of the aorta and inject a contrast agent, which flows down both extremities. In this scenario, you have a study requiring movement of the catheter into the aorta (36200).
    
Size Up Selective

For selective procedures, the cardiologist:
 
• punctures an artery and manipulates the catheter antegrade into a different branch artery, or
• manipulates the catheter from the aorta into a different vascular family

Selective arterial: Use 36215-36218 to report thoracic and brachiocephalic selective arterial procedures and 36245-36248 to report abdominal, pelvic and leg selective arterial procedures. In other words, you should use 36215-36218 for arteries above the diaphragm and 36245-36248 for arteries below the diaphragm, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. You should look to 36014-36015 for selective pulmonary artery catheterization.

Example: The nonselective example above would become selective if the cardiologist chose to "further visualize the lower extremities with an additional contrast injection into the contralateral common iliac artery," Collins says. As the catheter leaves the aorta and enters the contralateral common iliac artery, the correct code changes from the nonselective 36200 to the first-order selective catheterization code, 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family). 

Keep in mind: Carriers have their own ways that they want you to report these procedures. "Sometimes when they say 'selective,' the catheter is not just at the origin of the peripheral vessel but 'advances' the catheter into that vessel," says Pat Gajewski, CPC, a full-time coder at Consultants in Cardiovascular Disease Inc. in Erie, Pa.