General Surgery Coding Alert

Question: Can I bill 36215 and 36216 together for a first and second order thoracic branch arterial catheter placement? Or should I use +36218 with 36215 because 36216 includes 36215 (because the physician went through the first branch to get to the second)?

Kentucky Subscriber

Answer: The appropriate code choice will depend on the documentation for the specific case and the specific vessels involved, but because you mention going through one vessel to get to the other, 36216 (Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family) is the most likely candidate.

36215: The CPT® rule is that you should include catheter introduction and all lesser-order selective catheter positions in your selective vascular catheter code when they are both:

• Within the same vascular family, and
• Accessed through the same approach.

So if the case you describe involves moving the catheter through a first-order vessel just to move on to the second order destination vessel in the same family, you should not report first-order code 36215 (... each first order thoracic or brachiocephalic branch, within a vascular family) in addition to 36216.

Correct Coding Initiative (CCI) edits affirm this limitation by listing 36215 as a column 2 code with 36216.

+36218: You should not use +36218 (... additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family [List in addition to code for initial second or third order vessel as appropriate]) with first-order code 36215. CPT®’s note with +36218 states it is appropriate for use with 36216 and 36217 (... initial third order or more selective thoracic or brachiocephalic branch, within a vascular family).