Radiology Coding Alert

Question: I'm new to the interventional side of radiology coding, and I'm having trouble distinguishing between nonselective and selective vascular services. What exactly distinguishes the two types?

Wisconsin Subscriber

Answer: In nonselective procedures, the physician does one of the following:

• Places a catheter directly into an artery or vein and stops
• Manipulates the catheter from another artery into the aorta and stops
• Manipulates the catheter from another vein into the superior or inferior vena cava and stops.

Tip: You're more likely to see documentation that the physician entered a peripheral vessel and manipulated the catheter into either the aorta or vena cava than that she placed the catheter directly into the aorta or vena cava. The direct translumbar approach is an exception and has its own access code, 36160 (Introduction of needle or intracatheter, aortic, translumbar).

You should use intra-arterial and intra-aortic codes 36200 and 36100-36160 to report nonselective arterial procedures, and use intravenous codes 36010 or 36005 for nonselective venous procedures.

Selective: For selective procedures, the physician does one of the following:

• Punctures an artery and manipulates the catheter into a different branch artery
• Punctures a vein and manipulates the catheter into a different vein
• Manipulates the catheter from the aorta into a branch artery
• Manipulates the catheter from the vena cava into a branch vein.

Consider 36215-36218 to report thoracic and brachiocephalic selective arterial procedures and 36245-36248 for separately reportable abdominal, pelvic, and leg selective arterial procedures. You should look to 36014-36015 for selective pulmonary artery catheterization codes.

You only have two codes to choose from for selective venous catheterizations: 36011 and 36012.