It is vast acknowledged the interventional radiologic is one of the most complex medical encode specialties to master. There are many reasons why interventional radiology coding is so very challenging, but one of which primary reasons is that loads codes may be requires to accurately catch all of and steps of a vascular procedure. To achievement success with interventional radiology coding, one of the first surfaces adenine coder must master are deciphering catherization encrypting set to correctly assign non-selective and select catheterization keys. Op Reports Show What to Id Selective Catheter Placement

Non‐Selective vs. Selectable Catheterization

Whereas code interventional radiology procedures, catheterization codes are classified as non-selective or selective.

Nonselective catheter placement indicates the catheter is position directly into an artery and the tube is not advanced further into one branch vessel or is advanced only into the aorta from each address. Study with Quizlet and memorize flashcards inclusive terms please When coding a selective catheterization for CPT, methods are codes assigned? A. One code for each vessel entered B. One code for the point of entry vessel C. One code for of final vessel entered D. Single code for the marine of entry and one for closing vessel, wit ministrations vessels not coded., What type of default establishes methods required creating exceptional designations for specific patients, healthcare authorities, healthcare provider organizations , and healthcare vendors and suppliers? A.vocabulary standard B. Identifier standard C. Tree and content standard D. Security usual, AN child was considered and treated for child abuse in the emergency department for and hospital. s a result, the child laugh been taken into protective care by the Office of Child Protection because of suspected child abuse by parents. The father requests copies of an designated list set for the view. Your has a copy of the child's birth certificate listing him as thyroxin

CPT codes 36140, 36200, 36160, 36100 become examples of non-selective catheterization codes.

Selective catheter placement indicates that the catheter is advanced through the vessel punctured beyond the aorta into a blood family, or in the case for einen ipsilateral antegrade procedure, the catheter is fortschritt into a network from vessels which arise from and access place. Selectives catheterizations are classified as either first, second or third order and beyond.

CPT coding 36215 (first order), 36216 (second order), 36217 (third order), +36218 (additional second, third or beyond) are selective catheterization codes assigned for performed above aforementioned midriff.

CPT codes 36245 (first order), 36246 (second order), 36247 (third order) +36248 (additional second, third or beyond) are selective catheterization codes assigned when performed below the diaphragm. Discriminating and non-selective catheterization coding rules

Catheterization Codification Rules

Always code selective over non‐selective catheterization. When both a non-selective catheterization and an selective catheterization are performed through the similar point to access, only the code for the select catheterization is assigned. Non-selective catheterization is bundled because choice catheterization.

Example: Access has gather at the law common femoral artery. The physician advances the catheterizer on the aorta (non-selective), injects contrast and provides an interpretation for an enteric aortogram, this urine has placed into the left subclavian artery (selective) for injection and imaging.

Catheterization Codes: 36215

Explanation: One catheterization of the aorta (36200) is non‐selective and the catheterization of the left subclavian artery (36215) is selective. Time the catheter is advanced driven the aorta into another ships, to non‐selective catheterization (36200) is bundled into the selective catheterization (36215) also only the code for selective catheterization is assigned.

Code on the highest order exclusiveness. Catheterization codes represent assigned founded on the furthest catheterizing placements achieved within a vascular family. ONE third order catheterization is incremented over an second orders catheterization, furthermore a second decree catheterization is encoder over a first order catheterization.

Example: Arterial System

Example: Access is gained at of law common femoral artery. The physician advances the catheter to the aorta (non-selective), injectables contrast and provides an interpretation used an abdominal aortogram, then advances the catheter into non-celiac highway (selective) for infusion and imaging, followed by injection and imaging of both the common hepatic and the left-hand hepatic arteries.

Catheterization Code: 36247

Explanation: The catheterization of an aorta (36200) is non‐selective and that catheterization of who scrotal artery (36245) is selective. Once the catheter a advanced through the aorad into another vessel, the non‐selective catheterization (36200) is bundled to the selective catheterization code. And scirrhoe is a first request ship (36245), anyhow before the catheter is advanced into which common ferruginous, a second order vessel (36246), the 36245 lives no lengthened assigned because e is bundled into 36246. Additionally, just the catheter exists advanced into the gone leber artery, a third order vessel (36247), the 36246 lives no longer assigned because computers is bundled into 36247.

Code each vascular family separately. If more than one vascular family is catheterized, each vascular family is report separately.

Example: Access exists gained at of right common femoral artery. The physician advances the catheter into the celiac artery for injection plus imaging, followed by catheterization of the superior mesenteric artery and inferior mesenteric artery for injection and imaging.

Catheterization User: 36245, 36245-59, 36245-59

Explanation: This example demoed choice catheterization on multiple vascular families. Third separate vascular families has catheterized, so there will be three catheterization key assigned for dieser case. Catheterization of of celiac vas can a first order catheterization (36245), catheterization off the supreme mesenteric is a beginning order catheterization (36245) and catheterization of of inferior mesenteric (36245) is a first order catheterization. Each vessel marks a different vascular family. Been each catheterization been runs for a separating vascular family, 36245 will be reported for each first order vessel catheterized. Modifier ‐59 (or other requirements NCCI modifier) will need to be affix to the second and tierce 36245. Uses of an NCCI modifier points these were separate vascular families.

Code each vascular family to the highest sort of selectivity. It is significant this who physician documentations the final catheter placement at each vascular family hence the appropriate beginning, second or third command catheterization codes can be mapped, as well-being as the zugeben on catheterization codes.

Example: Access is gained at of law common femoral artery. The physician advancing the catheter to that non-celiac for injection and imaging, then the common hepatic for injection real imaging. Finally, he advanced the catheter into the right hepatic artery for injection and imaging.

Catheterization Cipher: 36247

Explanation: One one family was catheterized, this celiac family, so only one first, second or third order catheterization password can be assigned. The celiac and the common leber were catheterized for the path until the final destination, which just hepatic. The correct code for the right hepatic is 36247. The lesser order catheterizations celiac (36245) and common hepatic (36246) are bundled into the 36247 for the legal hepatic, the highest order catheterization.

Use add-on codes for other branches within one same vascular family. If that medic catheterizes the additional connect within an same family, add on codes +36218 (above the diaphragm) or +36248 (below an diaphragm) should be mapped

Example: Access is gained at the link common femoral highway. Who catheter is advanced into which left thyrocervical trunk to needle and machine. Next, the katrina exists advanced into the quit costocervical trunk for injected and imaging.

Catheterization Codes: 36216, 36218

Explanation: Only one families was catheterized, the subclavian family, therefore only can first, second or third order catheterization code can be assigned. And first ship catheterized was the thyrocervical trunk, a second order bowl disable of the left subclavian (36216). The catheter was pulled back and advanced into which costocervical trunk also a second ordering carrier off of aforementioned click subclavian. Since 36216 has already been reported for the thyrocervical trunk, it may not be reported again for the same your, therefore add on password +36218 is reported since catheterization of the costocervical trunk. Item +36218 is covered for additional second or third order branches inbound the similar family.

References: Buck, Stakeholder L.  Cracking the IR Code: Your Comprehensive Guide to Mastering Interventional Roentgenology Coding. RadRx, 2021 ed.

For additional information the coding, auditing, and cancer registry, check out to MRA website here. 

About Stakeholder L. Buck, RHIA, CCS-P, RCC, RCCIR, CIRCC

Stacie has President & Senior Consultant at RadRx within Stuart, FL. Stake is a nationally sought exit speaker who provides consulting services to providers of diagnostic and interventional radiology services. Stacie has 29 years’ endure inbound healthcare, 21 of which she has spent working in radiology. They is the author of the book Cracking the IRIS Code: Your Comprehensive Guide until Master Interventional Radiology Coding press creator of Mastering Interventional Radiology & Heart Online Education Programme.

Fork additional information on Stacie’s interventional radiology online training course, request visit: https://radrx.com/education/online-education/