December 12, 2019coding
On Wednesday, December 11, 2019, ECLAT experts, Marie Thomas, Evelyn Santos, and Kara Carlisle hosted this quarter’s Experience The Brilliance Live webinar, titled “Introduction to Interventional Radiology Coding (Part 1)” . Throughout the live broadcast presentation, the audience was invited to participate by entering questions they might have about this topic for further explanation on our blog. Two topic-related questions were not able to be addressed during our live session. But, as promised, the responses to the questions have been answered below.
Question 1
Question: “the questions for brachiocephalic, right subclavian and right internal mammary, the catheter selection maybe 36217 and 36216 the brachiocephalic code goes away since they went to further branches.”
Answer:
Referencing 2019 Z Health Publishing “Vascular and Endovascular Surgery Coding Reference”, “Each vascular family is coded independently. As the selective vessel begins to branch, the codes become more selective. The initial segment of the vessel is considered a first order, the second distinct segment or branch is considered a second order, and the third branch is considered a third order. Any branch higher than a third order is also coded as a third-order or additional second or third order. “
In order to meet the criteria to code the catheter selections separately, each must be purposefully selected and examined.
Dr. Z further explains, “If you had to go through a section of a vessel to get to a more selective vessel, the catheter placement in the initial vessel is included in the higher-order selection. As a rule of thumb, a second-order includes all first-order placements and any non-selective placements along the path. A third-order includes all first, second, and non-selective placements along the path.”
This explains the difference in whether the coder reports each catheter selection as purposely being selected for examination and when the catheter is passing through or going through a vessel in order to reach a higher order selection.
Question 2
Question: “Why code 36248?”
Answer:
Catheter was placed in the aorta (36200)
Catheter selection of left common iliac (36245 LT, delete 36200)
Catheter selection of left superficial femoral artery (36247-LT)
The 36248-LT CPT code was inadvertently added on the 4th bullet of slide 21. It should not have been there as the catheter was parked in the SFA and imaged down the left leg vessel to show the left anterior tibial artery stenosis. The indented 5th bullet was meant to recommend that if two third-order selective catheterizations had been done (in this case the anterior tibial artery was not catheterized), then 36248-LT would have been appropriate to assign for the 2nd 3rd order vessel. I apologize for any confusion the adding of 36248-LT on the fourth bullet may have caused.
The appropriate catheterization codes for this scenario is: 36245-LT, 36247-LT
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