Four Steps Ease Billing of Same-session Peripheral and Coronary Catheterizations
Published on Sun Apr 01, 2001
When coronary and selective (peripheral) catheter placements are performed during the same operative session, often both services may be separately billed. But billing them together correctly can be confusing because peripheral and coronary intervention guidelines differ significantly. As a result, cardiologists sometimes bill inappropriately for peripheral services already included in the cardiac catheterization (such as aortography of the aortic root), and carriers may deny selective catheter placements that were appropriately billed (for example, if renal angiography is performed).
To minimize such errors and denials, cardiologists and their coders need to:
1. Determine if the peripheral catheter placement was selective, and, if so, find the appropriate code;
2. Select the appropriate imaging code(s);
3. Be aware of applicable national Correct Coding Initiative (CCI) edits; and
4. Provide clear and detailed documentation that indicates where the catheter entered the body, where it was finally placed, and why it was necessary.
Only Selective Catheter Placements Are Paid
Determining the correct code for a vascular procedure has been likened to calculating a taxi fare: It all depends on where you start and where you end. There are no fixed nonselective or selective arteries. Depending on where the catheter was introduced, any artery can be a selective destination.
When a catheter is introduced directly into the destination artery, or if there is a clear pathway that requires no manipulation, the catheter placement is nonselective (for example, if a catheter is placed in the ipsilateral common iliac artery via the common femoral artery to perform an angiogram). When such a procedure does not follow a cardiac catheterization, it should be coded 36140 (introduction of needle or intracatheter; extremity artery).
Note: Ipsilateral placements are introduced on the same side of the body as they are placed. Contralateral placements which usually require more manipulation and consequently are much more likely to be selective placements are introduced on the side of the body opposite the destination vessel.
If the same iliac angiogram is performed following a left heart cath (93510, left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), however, 36140 should not be billed if the heart cath was introduced via the same femoral artery. The CCI considers the nonselective iliac catheter placement a component of the heart cath because it has traveled along the same route, and bundles 36140 (and 36120, for the brachial artery) with 93510. Only selective vessels are separately payable. If the vessel placement is nonselective, youre unlikely to be paid for it, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.
During a selective placement, the catheter must be manipulated from a blood vessel into one of its branches. For [...]
