Cardiology Coding Alert

Question: I'm new to the peripheral vascular side of coding, and I'm having trouble distinguishing between nonselective and selective vascular services. What exactly distinguishes the two types?

Wisconsin Subscriber

Answer: In peripheral procedures, you may see any of the following:

Non-selective: The physician places a needle or catheter directly into an artery or vein with no further advancement (for example, a direct stick or direct puncture) past the punctured vessel, OR the physician places a catheter into any portion of the aorta or vena cava from any approach.

Selective: The physician guides, negotiates, manipulates, or advances the catheter into any arterial or venous vessel other than the aorta, vena cava, or initial vessel accessed.

Supraselective: The physician performs catheterization of a second or higher order vessel, essentially performing selective catheter placements within the original selective vascular family (for example, further selective catheterization within the celiac trunk, moving into the common hepatic and beyond).

Tip: The direct translumbar approach has its own access code, 36160 (Introduction of needle or intracatheter, aortic, translumbar).

You should use intra-arterial and intra-aortic codes 36200 and 36100-36160 to report nonselective arterial procedures, and use intravenous codes 36010 or 36005 for nonselective venous procedures.

Consider 36215-36218 to report thoracic and brachiocephalic selective arterial procedures and 36245-36248 for abdominal, pelvic, and leg selective arterial procedures. You should look to 36014-36015 for selective pulmonary artery catheterization codes. You have two codes to choose from for selective venous catheterizations: 36011 and 36012. 

Remember: Before reporting a catheterization code, be sure the service isn't included in a more comprehensive code for the same encounter. For instance, new-for-2012 renal angiography codes 36251-36254 and the revascularization codes introduced in 2011 (37220-37235) include catheterization, so you shouldn't report additional codes for catheterization.