In the Journey Through Vessels, Code Destinations, Not Waypoints
Here’s how to report catheter placement from puncture to journey’s end.
By Kimberly Engel, CPC
When deciding the “order” of a vessel for catheter placement, first ask yourself, “Where did the provider access the vessels for this catheter?” Femoral, brachial, jugular, and iliac are common access sites; other vessels also may be accessed.
For puncture only—that is, the provider stays in the access vessel and never travels to another—coding is fairly straightforward. Report either CPT® code 36000 Introduction of needle or intracatheter, vein for a vein or 36140 Introduction of needle or intracatheter; extremity artery for an artery.
It’s when the journey goes beyond the access point that one may wish there was a roadmap handy.
Start at Home
There are several orders of vessels past the access site. Zero order is the “home” or starting point. This almost always is the aorta (see illustration on preceding page). If the provider goes as far as the aorta and stops, report 36200 Introduction of catheter, aorta.
Note: Less frequently, the catheter is not advanced to the aorta, but is advanced directly from one vessel to another without passing through the aorta—for example, from the common femoral to the superficial femoral (in the same leg or ipsilateral), and perhaps to the popliteal or beyond. For more information on this topic, see the accompanying article “Op Reports Show How to Code Selective Catheter Placement.”
From the aorta, the ordered vessels branch outward like a network of streets, from highways (first order) to boulevards (second order) to side streets (third order) and down to alleys. The “streets” of the upper body (above the renals), including the neck, are coded with 36215-36218. The streets of the lower body (renals and below) are coded with 36245-36248.
Don’t Code Until You Reach the Destination
To continue the street analogy, imagine that the catheter is a car. Once in the car (introduction of the catheter), if the provider wishes to travel any further, he always must check in at home (the aorta). If he continues on from home, he is on a first-order street (vessel). If he turns again, he is on a second-order vessel, and so on. When coding this journey, report only the final destination; all stops along the way are included.
For example, the catheter enters the right common iliac artery. The physician drives the “car” (catheter) into the aorta (home) and over to the left common iliac. This would be a first order, lower body vessel, 36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family. You would not code the access (36140) or the zero order aorta code (36200) because they were along the path that had to be taken from the puncture to the final destination.
What if the physician needs to drive further, into another vessel, from the aorta, such as the left superficial femoral? In that case, there would be three street names along the way. This would then be a third-order placement, and reported 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family.
As a final example, the provider documents: “Right common iliac access. Catheter advanced to the aorta. Imaging shows normal anatomy and no disease or defect. Catheter then advanced into the left external carotid artery … final placement in the left internal carotid.” The final code is 36216 Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family for a second order, upper body vessel.
Note: All examples are based on normal anatomy. There can be variations in the vascular anatomy that will change the order of vessels you code.
The same coding principles illustrated above apply to venous catheter placement outside the heart (36010-36012).
Keep reading: In future articles, look for more advanced concepts, such as how to determine vascular families, coding for second- and third-order vessel catheter placements beyond the initial placement, bypass vessels, and abnormal anatomy.