Radiology Coding Alert

See if you can pick out which vessels were simply 'on the way' and which merit codingIn your radiology practice, catheter placement goes hand in hand with interventional procedures, but differentiating a second-order from a third-order placement can be a challenge. To help you navigate the brachiocephalic family of arterial catheter coding, make your way through this how-to lesson, including the four documentation trouble spots you need to watch out for.Learn by Example: Real Cath ReportYou can hone your interventional skills by seeing how to apply the rules to a case that could cross your desk at any time. Review the rules in "Bulletproof Your Coding by Acing Selective Vs. Nonselective" on page 4. Then analyze this report shared by Brenda Cole, CPC, of Dexios Corp. in Greenwood, S.C. Your goal is to determine the appropriate code for each injection procedure performed, assuming the full report meets all documentation requirements.Procedure: The right femoral artery is utilized for vascular access and a 5 French H1 catheter was introduced into the right vertebral, right internal carotid and right external carotid arteries, and multiple injection runs performed. Images show no vascular abnormality associated with vertebral circulation or the external carotid artery circulation. On internal carotid artery injection there is a small dilated venous structure that corresponds to the abnormality seen on CT angiography performed on [date omitted]. This is in the medial cranial fossa on the right just medial to the tip of the temporal lope. This fills in the normal mid venous phase and has the appearance of a small venous angioma. No other vascular anomalies are identified.ID Access Point to Start the TripProperly identifying the vascular access site is a common documentation trouble spot, notes interventional coding expert Sheldrian Leflore, BA, CPC, director of revenue management for Integrated Revenue Management of Carlsbad, Calif.The sample report gets an "A" for identifying the right femoral artery as the vascular access site. You need to know this site as a first step to choosing between selective and nonselective codes.Three other areas that the radiologist needs to document carefully are the following, Leflore says:1. where the catheter terminated in each vessel2. the catheter's location for injection procedures3. the vessels targeted for angiography.Benefit: If you know this information, you'll be able to distinguish billable imaging from roadmapping, guiding shots, and other nonbillable services, Leflore says.Read on to see how knowing this information affects your choice of codes for the sample procedure.Choose Code Based on Highest OrderIn the sample report, the next site the radiologist documents after femoral access is the right vertebral artery.You can trace the path from the right femoral artery introduction to the right vertebral artery. The radiologist would advance the catheter through the [...]