Cardiology Coding Alert

Question: Which catheterization code(s) should I report when the cardiologist uses the right femoral vein as the access point and advances the catheter to the right main pulmonary artery, performs an angiogram, moves to the left artery and performs an angiogram, and diagnoses pulmonary emboli? This was not a right heart catheterization.

Colorado Subscriber?

Answer: As you note, the cardiologist wasnt performing a right heart catheterization to measure heart function.

You should code the service as described with 36014 (Selective catheter placement, left or right pulmonary artery). And because the service occurred in both the left and right arteries, you should report the code twice based on your payers preference.

(And dont forget 75743 [Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation] for the supervision and interpretation).

You have to pay attention to anatomical descriptive terms when coding pulmonary cath placement.

Main: If the radiologist had advanced the cath only to the main pulmonary artery level, you would have reported 36013 (Introduction of catheter, right heart or main pulmonary artery). Note that the main pulmonary artery (or pulmonary trunk) originates in the hearts right ventricle, is only about two inches long, and branches into the left and right pulmonary arteries.

Left and right: As in your question, report 36014 when the service terminates in the right pulmonary artery.The same holds true for the left. You may see these referred to as the main pulmonary arteries, so be sure you determine correctly whether the documentation refers to the trunk or the right or left pulmonary arteries.

Segmental/subsegmental: If the radiologist advanced the catheter into a segmental or subsegmental pulmonary artery, 36015 (Selective catheter placement,segmental or subsegmental pulmonary artery) would be the appropriate cath code. There are right and left segmental and subsegmental arteries, so focus on the terms segmental and subsegmental when choosing this code.

Remember: You should code only the most distal (farthest/most selective) catheterization, so if the cardiologist performed imaging in the right pulmonary artery and then advanced the catheter into the right segmental and performed imaging, you would report 36015, not 36014, for catheterization.