Cardiology Coding Alert

One size doesn't fit all for catheter coding.

Take a gander at the average patient's anatomy (Figs.1, 2), and you'll see the left common carotid (LCC) originating from the aorta. If you know your catheterization coding, that makes the LCC a first order vessel.But in many other patients, the LCC shares a common origin from the aorta with the innominate or the LCC originates from the innominate, says Jim Collins, CCC, CPC, president of CardiologyCoder.Com Inc. in Saratoga Springs, N.Y. You may see this anomaly called a bovine arch (Figs. 3, 4).

Impact: When you report a first-order LCC catheterization from a femoral approach, you should report 36215 (Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family). But for patients with a bovine arch, the LCC is a second order vessel, meaning you should report 36216 (... initial second order thoracic or brachiocephalic branch, within a vascular family) when the catheter terminates in the LCC. Medicare's national nonfacility rate for 36215 ($1107) is $105 less than the rate for 36216 ($1212). Or if you're coding a service performed in a facility, 36216 will earn you $30 more than 36215.