Radiology Coding Alert

Bilateral procedure)."

Helpful hint: Check with your carrier for modifier guidelines. "Some carriers want 36245 listed once with modifier -50 while others want 36245 listed twice with modifier -59 (Distinct procedural service) or a modifier -50 on one of them " says Jim Collins CHCC CPC president of Compliant MD Inc. "Despite the standardized code set requirements established by HIPAA there is little consistency among payers in many areas." Some insurers prefer that you report 36245-LT (Left side) and 36245-RT (Right side).

Coding example 2: The physician may need to puncture both femoral arteries. For instance on one side he places the catheter into the aorta for an aortogram but cannot advance the catheter over the aortic bifurcation. He punctures the other femoral artery and places the catheter in the popliteal artery.

In this situation you can code both catheter placements Wholey says. You should report 36246 (Selective catheter placement arterial system; initial second-order abdominal pelvic or lower-extremity artery branch within a vascular family) for the ipsilateral second-order catheter placement in the popliteal and bill 36200 (Introduction of catheter aorta) for the catheter to the aorta she says. "This is one case where you can bill a nonselective cath placement as well as a selective one because there are two puncture sites."

Be sure to add modifier -59 to 36200 says Rhonda Burge CPC coding and billing supervisor for Mid-Ohio Vascular Consultants in Columbus. "Otherwise 36200 will be bundled into 36246 " she says.

3. Same Family: Check Multiple Cath Positions

The physician may place the catheter in two selective positions within the same vascular family. In some of these cases you can bill for multiple catheter placements depending on the final catheter positions.

Coding example 1: From a right femoral access point the radiologist positions the catheter in the right subclavian artery performs imaging and then repositions the catheter in the right common carotid artery. Both of these vessels are branches of the brachiocephalic/innominate artery that arises at the aortic arch and they both represent second-order selective catheter positions.

For the initial second-order catheter position above the diaphragm you should report 36216 (Selective catheter placement arterial system; initial second-order thoracic or brachiocephalic branch within a vascular family). Report the second catheter position with +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]).

Here's why: CPT indicates that you should report one of the selective catheter placement services with the regular code that indicates the initial/selective catheter placement (36215 36216 or 36217 for vascular families above the diaphragm; or 36245 36246 or 36247 for vascular families below the diaphragm).

You should report 36218 or 36248 for the additional second- or third-order selective catheter placement depending on whether the vascular family arises above or below the diaphragm.

Don't miss: The key to billing multiple catheter positions in the same vascular family is that the multiple positions cannot be along the same path Collins says. For such procedures the physician would have to retract the catheter tip proximally through the bifurcation/trifurcation and then advance the catheter down a different pathway so it is distal to the bifurcation/trifurcation he says.

Coding example 2: The radiologist positions the catheter tip in the right vertebral and then in the brachiocephalic artery.

Here's why: In this case you would report only one code (36217 Selective catheter placement arterial system; initial third-order or more selective thoracic or brachiocephalic branch within a vascular family) assuming a femoral puncture site. You would not need to report the additional vessel code (36218) because the physician navigated the brachiocephalic artery en route to the right vertebral.

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