Cardiology Coding Alert

When your cardiologist performs peripheral vascular (PV) catheterizations, you should use three main factors to determine the level of selectivity: the access (sites), catheter movement, and the most selective position in each vascular family.

You can recoup about $250 if you bill 36245 (Selective catheter placement, arterial system; each firstorder abdominal, pelvic, or lower-extremity artery branch, within a vascular family) when the physician performs a first-order selective cath procedure, according to the 2004 Physician Fee Schedule. But if the physician performs a nonselective catheter placement only (36200, Introduction of catheter, aorta), you'll collect about $150, based on national averages.

Other frequently reported nonselective codes include 36120 (Introduction of catheter or intracatheter; retrograde brachial artery) and 36140 (... extremity artery), each worth about $100, based on national averages. To ensure that you collect the maximum reimbursement due, you should always verify whether your physician documented a selective or nonselective procedure.

Use the following PV coding pointers to help direct your code selection:

1. Into the Aorta Is Nonselective. When the physician moves the catheter into the aorta from any access site, you should report a nonselective procedure (36200, Introduction of catheter, aorta; and 36140).

"A nonselective catheter placement means that the catheter is placed directly into an artery or into the aorta and not manipulated any further into a more selective branch," says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.

2. Away From the Aorta Is Selective. If the physician moves the catheter away from the aorta and through a bifurcation or trifurcation in the vascular family that was initially punctured, you should use a selective catheterization code (36215-36217 and 36245-36247).

3. In Another Vascular Family Is Selective. If the physician advances the catheter into the aorta and places it into a vascular family other than the one unctured, you should use a selective catheterization code.

Site and Selectivity Determine PV Code

If the physician moves the catheter away from the aorta, you should report a first-order catheterization (36215, Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch, within a vascular family) if the vascular family begins above the diaphragm (such as the subclavian, carotid, brachiocephalic and vertebral arteries), or 36245 if the vascular family begins below the diaphragm (such as the renal, iliac, femoral and popliteal arteries).

Each time the physician navigates a bifurcation or trifurcation within that same vascular family, the level of selectivity increases and so does the appropriate CPT code, until you reach 36217 (... initial third-order or more selective thoracic or brachiocephalic branch) for cath placements above the diaphragm or 36247 (... initial thirdorder or more selective abdominal, pelvic, or lowerextremity artery branch) for procedures below the diaphragm.