General Surgery Coding Alert

Report catheter placement according to location and vessel In general surgery practice, catheter placement goes hand in hand with many surgical procedures, but differentiating a second-order from a third-order (or first-order) placement can be a challenge. To help you navigate the families and branches of arterial catheter coding, we offer this basic how-to lesson. Learn Your Anatomy You should select catheter placement codes according to the vascular family, and the branches within that family, that the surgeon accesses. To understand these codes, however, you must first learn about vascular anatomy. You can think of the patient's aorta (the primary vessel leading from the heart) as the trunk of a tree. Each "branch" that arises from the aorta is considered a first-order vessel. When this branch splits, you have two second-order vessels or branches, says Jackie Miller, MA, CPC, senior consultant at Coding Strategies Inc., a healthcare reimbursement consulting firm in Dallas, Ga. The brachiocephalic is a first-order vessel that arises form the aorta. It splits into the right subclavian and the right common carotid, each of which is a second-order vessel, Miller says. The right common carotid further splits into the right internal carotid and right external carotid, both of which are third-order vessels. All of the arteries fed by a first-order vessel are part of the same vascular family. In the explanation above, both the right common carotid and the right subclavian are part of the same vascular family. These definitions are very important in determining which catheter placement code to choose, Miller says. Moving From Larger to Smaller? It's Selective Selective catheterizations are distinct from other types of vascular catheterizations because in selective caths, the surgeon moves the catheter from a larger blood vessel into a smaller one. The aorta is the largest blood vessel in the body, so movement into the aorta is never a selective catheterization. However, after the catheter enters the aorta and the surgeon advances the catheter into an artery in a vascular family other than the family in which the catheter placement gained vascular access, you should consider that catheter placement as selective, says Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C.

Coding solution: When the catheter first enters the vascular family, you should report it as a first-order selective catheter placement using 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family) or 36215 (Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch, within a vascular family), depending on where the vascular family originated (below or above the diaphragm), Collins says. Define Selectivity by Order When the surgeon advances the catheter tip through a bifurcation or trifurcation, [...]