Basics of CPT code 36215, 36216, 36217 & 36218
A selective catheter placement is performed in a thoracic or brachiocephalic branch of a single vascular family of the arterial system. A catheter is introduced into an extremity artery, with the preferred introduction site being a femoral artery, although an upper extremity artery may also be used. A small skin incision is made over the planned insertion site. An introducer sheath is placed in the artery and a guidewire inserted. If the right femoral artery is used, the guidewire is manipulated through the femoral and iliac arteries and into the aorta.
A catheter is advanced over the guidewire into the aorta. The guidewire is advanced as needed and the physician then manipulates the catheter over the guidewire into a first order thoracic or brachiocephalic branch off the aorta. The physician continues to selectively advance the guidewire and catheter through higher order branches (second, third, and beyond) until the catheter is situated in the highest order branch requiring evaluation. The guidewire is removed. Injection of medication and/or radiopaque contrast media is performed as needed.
Report CPT code 36215 if a first order branch is the highest order branch catheterized within the vascular family, report CPT code 36216 if a second order branch if the highest order branch catheterized, assign CPT code 36217 if a third or higher order branch is the highest order branch catheterized.
Description of CPT code 36215, 36216, 36217 & 36218
Use CPT code 36218 for catheterization of each additional second, third, or higher order thoracic or brachiocephalic branch within the same vascular family.
For intravenous procedure, use CPT code 36000, 36005-36015, and for intra-arterial procedure, report CPT code 36100-36248.
Always use CPT code 36218 in conjunction with 36216, 36217, 36225, 36226
Do’s And Dont’s for Coding Arterial Catheter Placements codes
- Do code to where the tip of the catheter is.
- Do code each individual vascular family separately with the same rules using modifiers as necessary.
- Do use codes 36215-36218 for selections above the diaphragm and 36245-36248 for selections below the diaphragm, unless selective catheter placements are for diagnostic renal or cervicocerebral angiography, carotid/vertebral stent placements, or lower extremity endovascular revascularization. (An exception is that code 36218 can be used with codes 36225 and 36226 in certain circumstances.)
- Do code each approach from a different access site separately.
- Do code the aorta placement (36200) instead of other non-selective codes if the aorta has been entered
There are two codes that describe the coding of each additional second order, third order, and beyond selective catheter placement in the same vascular family: 36218 and 36248. As vessels are traversed to get more selective, each lower level of selectivity vessel that is passed through is included in the final destination. Some vessels can only be selected by pulling the catheter back and going a different route in the same vascular family. This is where additional second or higher selective catheter position codes 36218 and 36248 apply. When there is additional work to get to a branch vessel after a second or third order selection has been performed, the “each additional” code should be used.
Diagnostic arteriography is an invasive procedure for the purpose of evaluating vascular disease. The process involves passing a needle or catheter through the skin under fluoroscopic guidance into an artery followed by injection of contrast material and imaging of the vascular area in question using digital imaging or serial film imaging. The procedures for abdominal aortography or renal arteriography are most commonly done under conscious sedation.
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, or blood vessels and organs of the body, particularly in arteries, veins, and chambers of the heart. This LCD applies the term angiography when referring to abdominal angiography or renal arteriography.
Covered Indications
- Medical Necessity for Abdominal Aortography/Angiography
- Acute traumatic abdominal injury
- Aneurysm and other primary vascular abnormalities
- Occlusive disease, including evaluation for acute or chronic intestinal ischemia
- Acute GI hemorrhage
- Congenital anomaly
- Prior to arterial interventional procedures or open surgical procedures
References:
https://www.radiologytoday.net/archive/
https://www.sciencedirect.com/topics/medicine-and-dentistry/
http://connect.sirweb.org/e-irq/participate/viewirqarticle?DocumentKey