Cardiology Coding Alert

Question: The cardiologist documented catheterization of the right vertebral (third order) and left vertebral (second order) from femoral access. Does the third order code include the second order cath?

Maryland Subscriber

Answer: No. In the case you describe, you should report both the third and second order catheterizations because the vessels are classified as being in different vascular families. CPT Appendix L shows the relationships of different vessels so you can easily identify the families.

For the left vertebral, choose 36216 (Selective catheter placement, arterial system; initial second-order thoracic or brachiocephalic branch, within a vascular family). For the right vertebral, you should use 36217 (... initial third-order or more selective thoracic or brachiocephalic branch, within a vascular family).

Modifier must: The Correct Coding Initiative (CCI) bundles 36216 into 36217, so you should attach modifier 59 (Distinct procedural service) to 36216 to indicate the cardiologist performed the services in separate vascular families.