Cardiology Coding Alert

It all comes down to vascular families, experts say

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 physician inserts the catheter multiple times in selective locations from the same access site?

The key to coding these peripheral vascular (PV) studies correctly is knowing whether the cardiologist catheterized more than one vascular family during the procedure, PV coding experts say. Don't Bill for Catheter Exchanges Frequently, a physician will perform a diagnostic study with the catheter in a selective location and exchange the diagnostic catheter for an interventional catheter before treating the lesion.

What to do: When the cardiologist performs a cath placement for a selective left renal artery study from a femoral access site, you would report 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family) for the selective renal artery study.

If the imaging shows a high-grade stenosis in the left renal artery and the physician decides to perform a percutaneous transluminal angioplasty (PTA), he would need to remove the diagnostic catheter and completely advance an interventional catheter to the same location. Even though the physician advanced a second catheter into the same selective location, you cannot report this service separately.

"You would only bill one catheter placement unless there is more than one access site," says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa. Track Cath Progress Through Vascular Families Even so, when the physician catheterizes more than one vascular family -- a network of arterial branches supplied by the same artery with a proximal connection to the aorta -- you may be able to bill multiple catheter positions. Here are the guidelines for two situations:

1. Separate Families: Code Highest-Order Cath If the physician selectively positions the catheter in two different vascular families, such as the contralateral lower-extremity and the left renal artery, you should code the highest-order selective catheterization in each vascular family separately.

Indeed, the Society of Interventional Radiology's (SIR) 2003 Coding Guide confirms that within each vascular family "the highest-order catheterization is coded."

This means that the highest-order cath placement code includes all lesser-order cath positions necessary to reach the target destination.

In addition, the procedure "will include all of the work involved puncturing the artery, negotiating any anomaly or stenosis, and advancing the catheter into the lumen of the target," the SIR guide states.

Coding example 1: From a femoral puncture site, the physician selectively places a catheter in both renal arteries. "These are two different vascular families, and the first-order catheter code, 36245, can be billed twice," Wholey says. "But since the procedure is bilateral, you would use [...]