Cardiology Coding Alert

Hint: There are three lower extremity vascular territories for coding.

In her HEALTHCON 2024 session “Mastering Extremity Vascular Documentation and Revascularization Coding,” Julie Agus, BA, COC, CPC, CPMA, CRC, CPC-I, CCC, discussed all things vascular including the difference between selective and non-selective catheterization and general coding guidelines to follow. Knowing which type of catheterization the physician used is vital to choosing the correct CPT^® code.

Read on to learn more.

Good Documentation is Key

Good documentation is crucial for accurate coding, Agus instructed. “The code selection depends on where the access site is and the path that the catheter follows and ends through the vascular system. Without the access site, you cannot code. You cannot make an assumption.”

The approach of the access site, including the laterality documentation, is a must, Agus added. There are no separate codes based on the approach in the extremity (open or percutaneous).

Differentiate Between Selective and Non-Selective Catheterization

To code catheterization successfully, you must understand the difference between selective and non-selective catheterizations, Agus said.

For example, with selective, the catheter is advanced from the vessel that was initially punctured into a smaller branch vessel or advanced into a different branch of the aorta (different vascular family).

On the other hand, with non-selective, the catheter does not advance beyond the vessel that is punctured into a smaller branch vessel or the final catheter position is within the main trunk (aorta or vena cava), according to Agus.

Nonselective catheter placement codes cannot be reported together with selective catheter placement codes if performed via the same access, Agus added.

She also said having the access site laterality documented will help the coder to see if it is contralateral or ipsilateral catheterization.

Don’t miss: Do not assign codes for the vessel through which the catheter passes on the way to the highest branch, Agus explained. For example, the physician accesses the left femoral artery and advances the catheter into aortic bifurcation. An aortogram is performed, and they manipulate the catheter into the right external iliac artery. This is a second order of the vascular family, so 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) should be reported. The catheter placement of the aorta is not reported.

Dive Into Upper and Lower Extremity Coding

For non-selective catheterization in the arm or leg, bill 36140 (Introduction of needle or intracatheter, upper or lower extremity artery), Agus said. This is a direct puncture.

On the other hand, non-selective catheter placement in the aortic arch is reported with 36200 (Introduction of catheter, aorta).

Once the catheter is advanced into a smaller branch vessel, use the selective catheter code from the series for upper 36215 (Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family) through +36218 (… 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 for lower 36245 (… each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) through +36248 (… 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)), Agus added.

Follow These General Coding Guidelines for Vascular Coding

There are three lower extremity vascular territories for coding: iliac, femoral/popliteal, and tibia/peroneal, Agus said.

There are four codes to describe selective catheter placement in the arteries below the diaphragm, including the abdomen, pelvis, and lower extremities. They are as follows:

• 36245 for first order
• 36246 for initial placement second order
• 36247 (… initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) for initial placement third order
• +36248 for additional selective catheter placement within the same vascular family. Agus added that +36248 should be assigned for each vascular family that is selectively catheterized.

Don’t miss: The descriptors for 36245-36247 mention “initial,” which means you can only bill one code of those three, according to Agus.

For catheter placement above the diaphragm, including the upper extremities, look to 36215 (through +36218, Agus said.