Overview
This lecture covers the approach to coding selective catheter placements and angiography per CPT guidelines, with a focus on understanding vascular branching and proper code selection for interventional radiology cases.
Understanding Vascular Branches and Coding
- Selective catheter placement codes depend on branch order (first, second, third, etc.) as defined in CPT guidelines.
- The aorta is usually considered the starting point; its direct branches are first order.
- The subclavian on the right is a second order branch (first is the innominate), but on the left, it is a first order branch.
- Catheter placements are coded based on where the dye injection occurs, not just the path taken.
Relevant CPT Codes and Usage
- 36216: Initial second order arterial branch in thoracic/innominate family.
- 36217: Initial third order or more selective arterial branch.
- 36218: Each additional second, third, or beyond branch (add-on code).
- 36225: Subclavian or innominate artery.
- 36226: Vertebral artery.
- 36223: Bilateral common carotids (with modifier 50 for bilateral).
- 76937: Ultrasound guidance for vascular access, professional component.
Visual Tools and Tips for Coders
- Use diagrams and Appendix L in your CPT book to visualize vascular families and branching.
- Tables and charts can help map procedures to specific codes.
- First order branch designation may change based on catheter entry point.
- Always code the documented sites of dye injection; undocumented procedures cannot be coded.
Common Coding Scenarios
- Each separate dye injection at a new branch counts as an initial or additional code, depending on branch order and family.
- Bilateral procedures require the appropriate modifier.
- Imaging (angiography) is reported separately for each vessel studied.
Key Terms & Definitions
- First Order Branch — Vessel branching directly from the starting vessel (usually the aorta).
- Second/Third Order Branches — Successive splits off the main vessel; determine code specificity.
- Add-on Code — CPT code used for each additional branching studied beyond the initial.
- Bilateral — Both sides of the body (right and left), typically requiring modifier 50.
- Appendix L — Section in the CPT manual illustrating vascular families and branch orders.
Action Items / Next Steps
- Review Appendix L and relevant diagrams in your CPT manual.
- Practice tracing catheter paths and determining order/branch for coding.
- Study additional anatomy if needed to better visualize vascular pathways.
- Complete any assigned readings or homework on vascular coding scenarios.