Radiology Coding Alert

Don't miss how appendix L can help make your claims cleaner

CPT and the AMA offer cut and dried rules about including nonselective procedures in selective ones. But applying them in the real world can be tricky. Get a leg up with this look at the essentials.

Vascular catheterization procedures are either selective or nonselective. You use nonselective codes when the radiologist places the catheter in the aorta, vena cava, or the vessel punctured and does not move the catheter further, explains AMA's CPT Assistant (October 2000).

Selective catheterization, on the other hand, means the radiologist advances the catheter into a first-, second-, or third-order or higher vessel, CPT Assistant states.

Above the diaphragm application: In normal human anatomy, there are three "great vessels" arising from the aortic arch: the innominate (or brachiocephalic) artery, the left common carotid artery, and the left subclavian artery. These vessels originating from the aorta are first-order vessels. A branch of a first-order vessel is second order, and so on.

Note the relationship among the first, second, and third-order arteries involved in the procedure in the sample report on page 1:

Tip: For a more detailed list of vascular families, see Appendix L of your CPT manual.

Rule: You should include catheter introduction and all lesser-order selective catheter positions within the same vascular family and accessed through the same approach in your selective vascular catheter code.

In other words, if the radiologist uses a nonselective procedure for part of a service, and then a selective catheter placement using the same access, you should report only the selective catheter placement, CPT Assistant instructs.