Cardiology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How do I code for a thoracic and abdominal aortogram? Report reads left brachial artery entered ... pigtail catheter guided into abdominal aorta where an abdominal aortogram was performed with run off into the iliac system. Next, the catheter was exchanged for an internal mammary catheter. This was placed into the abdominal aorta but was unable to be selectively engaged in the right renal artery. Single angiogram was performed. Next, this was exchanged for a pigtail catheter, which was placed in the ascending aorta, hooked to power injector, and aortogram with runoff to the iliacs was performed.

I do not understand the use of this phrase in code 36245, first order artery branch, within a vascular family. What are first- and second- order branches, and what constitutes a vascular family?

Cheryl Hathorn
Anniston, Ala.


Answer: The definition of a vascular family is a group of vessels (arteries) fed by the primary branch of the aorta or the vessels punctured. To code arterial procedures, you must know the original puncture site and where the catheter ends up, says Andrea Lamb, CPC, a coding and reimbursement specialist in Jane Lew, W.Va.

The aorta has several primary branches from which the secondary and tertiary branches arise. In the arterial system, catheter placement in a primary branch is described as first order. Selective catheterization of a secondary branch is second order, etc. In essence, code selection is determined by the final position of the catheter. Within each vascular family, the highest order catheterized is coded. This will include all of the work getting to the artery, including lesser-order procedures. Lesser branches of the same family are not coded separately.