Cardiology Coding Alert

Experts reveal the most overlooked services that you should be reporting You know you can't report nonselective catheter placement with selective placement from the same access site. But how should you report situations in which the cardiologist positions the catheter in multiple vascular families from the same access site? Our peripheral vascular (PV) experts have outlined what you should -- and shouldn't -- do when coding these tricky procedures. Key: Pay attention to whether the cardiologist catheterized more than one vascular family during the procedure, PV coding experts say.
Use 2 Codes for Additional Second-, Third-Order Branches You should code each vascular family separately. Determine the highest-order branch the cardiologist accesses in each vascular family. Example: From a right femoral access point, the cardiologist positions the catheter in the right subclavian artery, performs imaging and then repositions the catheter in the right common carotid artery. Both of these vessels are branches of the brachiocephalic/innominate artery that arises at the arch of the aorta, and they both represent second-order selective catheter positions.

For the initial second-order catheter position above the diaphragm, you should report 36216 (Selective catheter placement, arterial system; initial second-order thoracic or brachiocephalic branch, within a vascular family). Report the second cath position with +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]). Important: You should assign all additional second- and third-order branches within the same vascular family using either 36218 or +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]). Know the difference: You'll 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.
Avoid Coding 'On the Way' Services On the other hand, you shouldn't code the branches traversed as a pathway to the second- or third-order branches beyond. In other words, you should code only the highest-order catheter placement the cardiologist achieved within each vascular family. You should avoid coding the lower-order catheter placements that are "on the way to" the higher-order position.
Learn When You Should Report S&I Codes You should also separately code all supervision and interpretation (S&I) services, when your documentation supports it. Sometimes, you should not separately code the imaging S&I. For instance, you [...]