I often hear that interventional radiology coding is intimidating. It can be confusing when you don’t know the rules. One of the basics is knowing whether the catheter selection is non-selective or selective. Let’s look at the two different types of catheter placements and how you can tell which is which.
Non-selective catheterization is coded when –
- The catheter does not advance past the vessel that was accessed into a different vessel, or
- The final catheter position is in the main trunk – aorta or vena cava
Let’s look at an example of a non-selective catheterization:
The right common femoral artery is accessed, and the physician maneuvers the catheter to the abdominal aorta and performs abdominal aortography with iliofemoral run-off. He then removes the catheter, and the access site is closed.
This is a non-selective catheterization because the catheter is not maneuvered into any other vessel from the access site other than the aorta (trunk). He doesn’t place the catheter in the iliac or femoral artery for angiography so there would not be a selective catheter placement for the iliofemoral angiography, this was done strictly from the aorta. Code this scenario with 36200 for the catheter placement and 75630 for the abdominal aortography with iliofemoral run-off, don’t forget to append the 26 modifier to the 75630 if the physician is only performing the professional component.
Let’s look at another example of non-selective catheter placement:
The right brachial vein is accessed, and the physician advances the catheter to the inferior vena cava and performs a caval venography. The physician then removes the catheter and closes the access site.
Again, this is a non-selective catheterization because the catheter is not placed in any vessel other than the inferior vena cava. Code this scenario with 36010 for the catheter placement and 75825 for the venography, don’t forget to append modifier 26 to the 75825 if the physician is only performing the professional component.
Selective catheterization is coded when –
- The catheter is advanced from the vessel that was accessed to a smaller branch vessel, or
- The catheter is advanced into a different branch of the aorta
Let’s look at an example of a selective catheter placement:
The right common femoral is accessed and advanced to the aorta. Abdominal aortography is performed and then the physician advances the catheter into the left renal artery and performs renal angiography.
This scenario became a selective catheter placement when the physician selectively engaged the renal artery, which is a different branch off the aorta. Code 36251 for the selective left renal angiography; this code includes the catheter placement and both the abdominal aortogram and the left renal angiography in one comprehensive code.
Let’s look at another example:
The right brachial artery is accessed, and the catheter is advanced to the aortic arch and aortic arch angiography is performed. The catheter is then advanced into the vertebral artery and angiography is performed.
This scenario became a selective catheter placement once the physician advanced the catheter into the vertebral artery. The catheter code for this scenario would be 36226 and includes the cervicocerebral arch angiography in one comprehensive code.
Knowing your vascular families and the branch of each family is so important before attempting to code catheterizations. A vascular family is a group of vessels that branch off the same first order vessel. An example of vascular families would be the common carotid artery, a first order vessel off the aorta, and its branches, the external carotid artery, and the internal carotid artery.
In summary, knowing your vessel anatomy and the end catheter locations are the building blocks to properly code interventional radiology catheterizations.