Cardiology Coding Alert

Question: My cardiologist doesn't really clearly document his catheter placement when he performs the kissing balloon technique during peripheral angioplasty of the iliac arteries. Do they wind up usually in the aorta, or do they stay ipsilateral?


California Subscriber

Answer: If your cardiologist does not make the catheter placement clear, you should always ask him to specify. You should never base your coding on what is most common. The cardiologist's documentation will decide your codes.

For your purely clinical knowledge, cardiologists most often go into the aorta because they want the tip of the catheter to be fully across the lesion before they dilate it. Remember: "Kissing balloon angioplasty" refers to a technique during which the cardiologist angioplasties two arteries at the same time, typically due to an ostial lesion at the point of bifurcation. Cardiologists use the technique to prevent treatment in one artery from worsening the lesion in the other artery.

Important: When you code for catheter placement, you should base your code selection on the catheter's tip. The reason: Sometimes, cardiologists will use a guidewire, which is something that the catheter will ride over. In other words, the guidewires are like train tracks that the doctor will lay down in the arterial system. The catheter glides over the guidewire to get into position. Frequently, the guidewire will be in a more selective position than the actual catheter tip. Therefore, you should base your code on the catheter tip. 

Report multiple access sites separately: If you see that both catheter tips are going into the aorta (which is often the case), you should code this procedure as two units of 36200 (Introduction of catheter, aorta) or two separate line items, such as 36200-LT (Left side) and 36200-RT (Right side). The reason is that you should code each access site separately. From each access site, the catheter enters the aorta to facilitate the kissing balloon procedure.

Good advice: Make sure you illustrate to the doctor the impact of his documentation. Your cardiologists may not understand the coding difference in selectively moving the catheter into the abdominal aorta as opposed to leaving it in the lower extremities. But just show them the dollar amount and say, "Look, if you go into the abdominal aorta, this is the money you get. If you stay in the iliac, this is money you get. And without your telling me which is which, I have to go with the lesser-paying all the time."