Radiology Coding Alert

Your journey begins with defining the vascular family.

Selective catheterization procedure coding can pose challenges for your interventional radiology practice. To make your way to the correct code, you need to determine how many vascular families were involved in the catheterization. 

Defining vascular families: To be able to define vascular families, you need to determine the vessel punctured and how many vessels in the journey of catheterization arise from aorta. Check the procedure note to find out vessels enroute to the journey. Remember, the catheter must pass though the vessel and not just through the ostium. You spot the right selective catheterization code depending upon how far your physician took the catheter from the aorta or the vessel catheterized. Accordingly, you select from the following options: 

• 36245, Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
  
• 36246, Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
  
• 36247, Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
  
• +36248, Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family [List in addition to code for initial second or third order vessel as appropriate].
  

Check the order of vessels for the right code: You submit code 36245 are used when your physician inserts the catheter only into an artery that comes directly off the aorta or never advances beyond the vessel catheterized. 

Remember! You can use the first, second, and third order codes only once within any one vascular family.

Test your knowledge for catheter placement coding with these 5 questions.

1. Which of the following catheter placement codes do you submit when your physician places a catheter in the proper hepatic artery from a right femoral artery approach?

a) 36200
b) 36245
c) 36246
d) 36247

2. Which of the following catheter placement codes do you submit when your physician does a selective catheter placement in the left gastric artery from a right femoral artery approach?

a) 36200
b) 36245
c) 36246
d) 36247

3. Which of the following catheter placement codes do you submit for catheter placement in the middle colic and inferior pancreaticoduodenal arteries off the superior mesenteric artery from a right femoral artery approach?

a) 36246
b) 36246, 36246-59
c) 36246, 36248
d) 36247, 36248

4. Which of the following catheter placement codes do you submit for catheter placement in the right renal, left adrenal, and left gonadal veins from a right femoral vein approach?

a) 36011-59, 36012, 36012-59
b) 36011-59, 36012
c) 36012, 36012-59
d) 36011, 36011-59

5. Which of the following codes do you submit for catheter placements in the right pulmonary artery, right upper lobe pulmonary artery, right lower lobe pulmonary artery, left upper lobe pulmonary artery, and left lower lobe pulmonary artery from a left femoral vein approach?

a) 36014-50
b) 36014-50, 36015, 36015-59 x 3
c) 36015, 36015-59 x 2
d) 36015-50, 36015-59, 50.