Cardiology Coding Alert

Smart Start:

Smart Start: Review These Brachiocephalic Coding Essentials

You can't afford to ignore the 'include all lesser order codes' rule.

Before you jump into the case study on page 73, get a leg up with this look at the fundamentals.

See What Selective Means for Brachiocephalic

Vascular catheterization procedures are either selective or nonselective. You use nonselective codes when the physician places the catheter in the aorta, vena cava, or the vessel punctured, and he does not move the catheter further, explains AMA's CPT Assistant (October 2000). Note that non-selective also includes advancing the catheter toward the aorta. For example, if the doctor gained vascular access in the common femoral artery in the right leg and advanced to the common iliac in the right leg (retrograde advancement) the catheter placement is still non-selective (36140, Introduction of needle or intracatheter; extremity artery).

Selective catheterization, on the other hand, means the physician advances the catheter into a first-, second-, or third-order or higher vessel, CPT Assistant states.

Above the diaphragm application: In normal human anatomy, there are three "great vessels" arising from the aortic arch: the innominate (or brachiocephalic) artery, the left common carotid artery, and the left subclavian artery.

These vessels originating from the aorta are first-order vessels. A branch of a first-order vessel is second order, and so on.

Note the relationship among these selected first, second, and third-order arteries discussed in "Banish Brachiocephalic Service Confusion With This Step-by-Step Approach" on page 73 (you can see their anatomic relationship in the diagram on page 75):

First order (Vascular family)

• Brachiocephalic, aka Innominate

• Example code, 36215

Second order

• Right common carotid

• Example code, 36216

Third order

• Right internal carotid

• Right external carotid

• Example code, 36217.

Focus Coding on Most Selective Position

Rule: You should include catheter introduction and all lesser-order selective catheter positions within the same vascular family and accessed through the same approach in your selective vascular catheter code.

In other words, if the cardiologist uses a nonselective procedure for part of a service, and then a selective catheter placement using the same access, you should report only the selective catheter placement, CPT Assistant instructs.

Tip: For a more detailed list of vascular families, see Appendix L of your CPT manual, Betty Johnson CPC, CCS-P, CCP, CIC, advised in her session, "Back to Basics: Everything You Wanted to Know About Coding But Were Afraid to Ask," at The Coding Institute's July 2009 Coding and Reimbursement Conference in Orlando (

Other Articles in this issue of

Cardiology Coding Alert

View All