Vascular Catheterization

Vascular Catheterization - Coding

Vascular system anatomy and terminology to make reporting these procedures less challenging.

A thorough understanding of the anatomy and medical terminology of the vascular system is required to accurately code arterial vessel procedures. Here’s a quick run-through of clinical information and coding guidance to show you how order affects coding.

Order Matters

Please refer to Appendix L of the CPT® code book for the vascular families.

The aorta is the major artery. Each main vessel branching off the aorta is a first order vessel (e.g., left common carotid).

First order vessels have several vessels branching off them, designated as second order vessels (e.g., right subclavian and axillary).
Second order vessels have several vessels branching off them, designated as third order vessels (e.g., right internal carotid).
Third order vessels have several smaller vessels branching off them, designated as beyond the third order (e.g., left deep palmar arch).

Catheterization Can Either Be Selective or Non-Selective

For selective catheterization, the catheter is manipulated into other branches of the vascular family. Coding is based on the most distal vessel into which the catheter is placed.

For non-selective catheterization, the catheter is not manipulated or advanced into other branches of the vascular family.

The procedure for arterial catheterization typically begins with the placement of the catheter into the aorta. If the catheter is not manipulated or advanced into any other vessel beyond the aorta, report the procedure using:

36200 Introduction of catheter, aorta

First Order Vessels

If the catheter is placed in any first order vessel and it is not advanced beyond any other vessel, report the procedure using either:

36215 Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family

or

36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

The descriptions of these two codes divide the arterial system into two parts.

Second Order Vessel

If the catheter is manipulated or advanced from the first order vessel into the second order vessel but not beyond, report the procedure using either:

36216 Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family

or

32646 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family

First vessel catheterization is not reported because only the highest order catheter placement is reported for selective catheterization.

Third Order Vessels

If the catheter is manipulated or advanced into a third order vessel or beyond, report the procedure using either:

36217 Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

or

36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

Report additional catheter placements beyond a third order placement using:

+36218

Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate) Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

and

+36248

Do not use these codes when additional first order vessels are catheterized. Instead, report additional units of the codes describing first order vessel catheterization.

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