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Question: If a cardiologist performs catheterizations of the right vertebral artery (third order) and left vertebral artery (second order) from femoral access, can I just report the third-order catheterization code? Does it include the second-order work?

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Answer: No, you should not bundle the second-order catheterization into the third-order code in this case. That’s because the right and left vertebral arteries belong to different vascular families.

In catheterization coding, it’s essential to understand that each vascular family is billed separately — even if the catheterizations are of the same type (second or third order).

Don’t understand vascular families? The CPT^® guidelines, specifically Appendix L, define how vessels are grouped into vascular families. You can use this to determine whether separate codes (and potentially a modifier) are warranted.

Here’s how to code this situation:

• For the left vertebral artery (second order): Report 36216 (Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family).
• For the right vertebral artery (third order): Report 36217 (… initial third order or more selective thoracic or brachiocephalic branch, within a vascular family).

Modifier alert: Because 36216 is bundled into 36217 under the National Correct Coding Initiative (NCCI), you must append modifier 59 (Distinct procedural service) to 36216. This indicates that the procedures were performed in distinct vascular families and justifies separate reimbursement.

Takeaway for new coders: Don’t assume one third-order code covers everything. Always identify:

• The order of catheterization
• Whether the vessels are in the same or separate vascular families
• When a modifier is required to bypass an NCCI edit

This distinction is a common source of coding errors in cardiology, so reviewing Appendix L is a smart habit as you gain experience.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor