For coding Vascular procedures, it is very important to understand the concept of vascular families. Vascular families are located in Appendix L in CPT codebook. Vascular family is made of branches of arteries arising from aorta.
We have different vascular families from head to leg. You can refer the below image and know how they are arranged in the Appendix L page.
Now coming to the coding part, the vascular families are needed for coding the selective and non-selective catheterization procedures. Yes, the movement of catheter from one artery to other artery is best understand through this vascular family tree. Now, we will check one by one how we can code each of these vascular family.
Catheterization of Aorta
The first and basic principle to understand before coding vascular families, we have to know about aorta catheterization. Aorta is the largest artery and all the small arteries arises from the aorta. Hence, whenever a catheter has to move from one vascular family to another family, it has to pass through the aorta.
“Catheterization of Aorta is always Non-Selective Catheterization”
Catheterization of Aorta is coded with CPT code 36200. Selective catheterization starts when the catheter passes Aorta and enters into first, second and third branches of aorta. For example, a physician takes access in left femoral artery and passes the catheter from left femoral artery to Aorta and then reaches to right femoral artery. In this case, when the catheter is in Aorta, it is Non-selective, but when it crosses aorta and enter right femoral artery(another vascular family), the catheter enters into selective catheterization zone and here we will use selective catheter placement codes.
We will talk more about this in detail.
Upper extremity catheterization (CPT code 36215-36218)
CPT code 36215-36218 is used for selective catheter placement in a thoracic or brachiocephalic branch of a single vascular family of the arterial system. CPT code 36215 is used if a first order branch is catheterized within the vascular family, CPT code 36216 is reported when second order branch is catheterized, CPT code 36217 is reported when a third order branch is catheterized. CPT code 36218 is an add-on code for catheterization of each additional second, third, or higher order thoracic or brachiocephalic branch within the same vascular family.
Through same access when all the three order arteries are examined, we have to report only the highest order artery procedure code. For example, if first, second and third order are accessed through same access, then only third order artery code (36217) should be reported. Similarly, if only first and second order arteries are examined through same access, then we have to report only the second order artery (36216) procedure code. You can get more information about these procedures code here.
Selective Catheterization always included the Non-Selective Catheterization. Hence, aortic catheterization will get included with selective catheter placement procedures.
Also, there are separate code for selective catheter placement for common carotid or innominate artery (36222-36223), internal carotid artery, (36224), subclavian or innominate artery (36225) & vertebral arteries (36226). Also, there are two add-on codes for external carotid artery (+36227) & each intracranial branch of the internal carotid or vertebral arteries (+36228).
Codes from (36222-36228) includes all the angiography of the selected vessel circulation and all associated radiological supervision and interpretation.
Abdominal & Pelvic artery catheterization (CPT code 36245-36248)
Abdominal and Pelvic artery catheterization are coded with CPT code 36245 – 36248. Here, also we have use code 36245 for first, 36246 for second and 36247 for third order arteries. 36248 is used as add-on code. Here also, we have to report the highest order of arteries when all the orders of arteries are catheterized through same access.
Angiography is not included in these procedure codes. You have to use CPT code 75726 for coding abdominal and pelvic arteries.
75726 – Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation
Visceral angiography, selective or supraselective, with or without flush aortogram is a vascular procedure used to evaluate blood flow within the arteries of the bowel, liver, and/or spleen. This procedure may be used to diagnose bleeding or blockages in the vessels and to treat conditions such as trauma and tumors.
This procedure includes the flush aortogram (CPT code 75625) and hence should not be reported separately.
Renal Artery Catheterization (CPT code 36251-36254)
A selective catheter placement in the main renal artery and any accessory renal arteries is performed for renal angiography. There are only 4 CPT codes for renal artery catheterization. These CPT codes includes all the access, catheter placement, angiography and supervision & interpretation. Hence, should not be reported separately along with procedure code 36251-36254. Use CPT code 36251 for a selective unilateral renal angiogram and CPT code 36252 for a selective bilateral study. To know more about these codes, you can read the below post.
Renal artery catheterization procedure codes
Lower Extremity Catheterization (CPT code 36245-36248)
A selective catheter placement in an abdominal, pelvic, or lower extremity branch of a single vascular family of the arterial system is report with CPT code 36245-36248. The same principal is followed here also, only the highest order artery is reported when the exam is through same access.
All the percutaneous intervention procedures like angioplasty, stent, atherectomy of lower extremity are reported with CPT code 37220-37229. These codes include all the small procedures like access, angiography, catheter placement & supervision and interpretation.
Do not report the catheter placement codes (36245-36248) along with lower extremity interventional procedures (37220-37229). You can get more information about these CPT codes below.
References:
https://www.aapc.com/blog/22742-keep-vascular-coding
https://www.radiologytoday.net/archive/rt_081108p32
https://www.fortherecordmag.com/archives/031510