Difference between Selective and Non-selective catheterization
In interventional radiology coding, most of the medical coder get confuse with selective and non selective catheterization. Since minimal invasive procedure, are divided into two-part vascular and non-vascular procedure. Non-Vascular procedure are little easy to code compared with Vascular Procedure. Non-vascular procedure are direct codes like for biopsy, injection etc. Vascular procedure are typical to code and has certain rules to follow.
Vascular Family plays a key role to code vascular coding. Selective and non-selective catheterization concept can be clearly understood if one understand vascular family. Now, to code vascular procedure few thing has to remember
Rules to follow for Selective and Non-selective catheterization
Code Selective over non-selective catheterization
Selective catheterization is consider when the catheter moves beyond the aorta. If the catheter stays in the aorta it is considered as non-selective catheterization. So, when the catheter enter into an artery it has to pass through the aorta to enter any of the vascular family. So, when the catheter is placed any of the selective artery of the vascular family, then one has to code the order of that artery. Hence, when you code a selective catheterization code the non-selective catheterization code get included automatically.
For example, if we took an access and moves the catheter to aorta. So, till aorta it is considered non-selective catheterization. Once, the catheter moves beyond or away from aorta and enter into the vascular family, then the selected artery is coded as selective catheterization code.
Read also: coding tips for Selective and Non-Selective Venous catheter placement
Code each vascular family separately
since there are separate vascular family, depending of different anatomic location. So, we have vascular family for upper extremity, pelvic region and lower extremity. When we code selective catheter placement, each time to enter into a vascular family the catheter has to pass through aorta, so hence we have to give separate code for each vascular family.
For example, if the catheter has to enter into upper extremity family first it has to pass through aorta. Now, if you have to study low extremity as well, then the catheter has to again move from upper extremity to lower extremity. Now, when it moves from upper to lower region the catheter again passes through aorta, so we have to give another code for the second vascular family.
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Code the highest order per vascular family
This is very easy to understand. Since, we are inside a vascular family, the selective catheter placement should be coded of highest order. Since, the highest order is 3rd order, so if the catheter is placed in 1st, 2nd and 3rd order of the arteries. The highest 3rd order code will be enough to code in such cases since the 1st and 2nd order gets included with 3rd order code.
For example, if we have 1st order artery (36245), second order artery(36246) and third order artery (36247) studied of same vascular family. In this situation, the third order artery code 36247 will be enough to code, since 36245 and 36246 gets included in 36247 of same family.
Code each access separately
whenever we have study a particular artery one has to take separate access. Separate access means we have to start from the beginning the whole procedure. Each access cost the same amount of time and cost. Hence, for each access we have to code separately.
For example, if the physician studies an artery of upper extremity and artery of lower extremity, then he has to take separate access to study both field, hence they should be coded separately.
When to use 59 modifier in selective and non-selective catheterization
Suppose, the physician studies an artery of lower extremity. The code for the studied artery is 36237, 3rd order artery. Now, after the procedure the physician again with the separate access studies an artery within same family. This time he chooses second order artery 36246. Now, we cannot code these 36247 and 36246 together, since 36246 is included in 36247. So, to show they are distinct procedures we have to give 59 modifier to 36246. So, like this we have to be alert when and to which code we have to give 59 modifier.
In short, remember the below important points while coding Vascular catheter placement CPT codes
1.Always note the access site, especially if more than one, and what is performed via each access.
2.Note any anatomical variations that may affect vascular families and/or orders in a vascular family.
3.Note the route of the catheter.
4.Keep an anatomical coding chart handy to assist in code selection.
5.Select a code for the most distal catheter placement first.
6.If the catheter passed through any vessels that led to the most distant catheter placement, those catheter placements are included in the distal catheter placement.
Case studies or Coding examples
PROCEDURE:
From a right common femoral artery access, a wire is advanced into the aorta. A 5 French vascular sheath is placed. A catheter is used to catheterize the superior mesenteric artery. A selective angiogram of the superior mesenteric artery is obtained.
CPT code 36245
Rationale: The superior mesenteric artery is a distinct vascular family arising from the aorta. The
non-selective catheter placements in the access vessel and through the aorta are included in the selective catheter placement in the superior mesenteric artery. The superior mesenteric artery is the first branch off the aorta, so it is a first order selective catheter placement below the diaphragm (36245).
PROCEDURE:
The catheter is then advanced into the celiac trunk. A celiac angiogram is obtained. Catheter is removed and femoral angiogram taken through sheath to assess artery for closure. Sheath removed and manual pressure applied. Hemostasis achieved.
Rationale:
The celiac trunk is a separate and distinct vascular family arising from the aorta. The catheter was also placed in the first branch of this vascular family, so it is also a first order selective catheter placement below the diaphragm (36245).
Modifier -XS has been appended to indicate that the celiac selection was performed in a distinct vascular family (separate structure) from the superior mesenteric.
Case study 2
HISTORY:
Patient with hepatic neoplasm.
PROCEDURE:
From a left brachial artery access, a wire and sheath are placed. A pigtail catheter is advanced into the descending aorta. An aortogram is performed in frontal projection, left anterior oblique, and right anterior oblique. The pigtail catheter is exchanged for a diagnostic catheter, which is advanced into the celiac trunk. A selective angiogram of the celiac trunk is performed. The catheter is advanced into the common hepatic artery. A selective hepatic angiogram is performed. The vascular sheath is removed from the left arm and manual compression held until hemostasis is achieved.
Code(s): 36246
PROCEDURE:
From a left brachial artery access, a wire and sheath are placed. A pigtail catheter is advanced into the descending aorta. An aortogram is performed in frontal projection, left anterior oblique, and right anterior oblique. The pigtail catheter is exchanged for a diagnostic catheter, which is advanced into the celiac trunk. A selective angiogram of the celiac trunk is performed.
Rationale:
The approach was from the brachial artery in this example. The approach doesn’t affect selective catheter placement coding in the visceral vessels, as they arise from the aorta.
The celiac vascular family was selectively catheterized so the nonselective aortagram would be included in the selective selection of the celiac.
PROCEDURE:
The catheter is advanced into the common hepatic artery. A selective hepatic angiogram is performed. The vascular sheath is removed from the left arm and manual compression held until hemostasis is achieved.
Rationale:
The catheter was placed in the celiac trunk then advanced to the common hepatic artery. The catheter placement in the celiac trunk is included in the more selective catheter placement in the hepatic artery. Only the second order catheter placement in the hepatic artery is reported (36246).
Hope, you can code selective and non-selective catheterization procedures comfortably after reading this article. Please share if you liked the article.