General Surgery Coding Alert

Question: Please help with coding for the following scenario:Surgeon entered the left brachial artery using a needle and Seldinger technique under fluoroscopic guidance, and catheterized the aortic arch and distally to each iliac and femoral artery. Performed arteriography using contrast, then de-catheterized, applying pressure on the brachial artery. Delaware SubscriberAnswer: The correct code is 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family), because the common femoral artery is the most distal vessel catheterized in the procedure. You should append modifier 50 (Bilateral procedure) because the surgeon documented catheterizing "each" iliac and femoral artery. Look to Appendix L: CPT® provides a helpful coding tool in Appendix L --" a chart of the vascular families. The chart assigns branches to first, second, and third order, plus a listing of branches beyond third order. When you're coding for selective catheterization, this [...]