General Surgery Coding Alert

Question: Our practice recently added a surgeon who specializes in peripheral vascular procedures, and I'm having trouble understanding how to distinguish between non-selective and selective procedures for coding purposes -- could you help?

Florida Subscriber

Answer: CPT® codes divide peripheral vascular procedures into three levels as follows:

1. Non-selective: The surgeon places a needle or catheter directly into an artery or vein with no further advancement beyond the punctured vessel (such as a direct stick or direct puncture). Alternately, a non-selective procedure could involve placing a catheter into any portion of the aorta or vena cava from any approach.

You should use intra-arterial and intra-aortic codes 36200 and 36100-36160 to report nonselective arterial procedures, and use intravenous codes 36010 or 36005 for nonselective venous procedures. The direct translumbar approach has its own access code -- 36160 (Introduction of needle or intracatheter, aortic, translumbar).

2. Selective: The surgeon performs a selective peripheral vascular procedure when he punctures the vena cava, aorta, or other initial vessel, then advances the catheter into a branch of the initial arterial or venous vessel. The surgeon may advance the catheter again into third order branches or beyond, thus performing a more selective catheterization

Consider 36215-+36218 to report thoracic and brachiocephalic selective arterial procedures and 36245-+36248 for abdominal, pelvic, and leg selective arterial procedures. You should look to 36014-36015 for selective pulmonary artery catheterization codes. You have two codes to choose from for selective venous catheterizations: 36011 and 36012.

Remember: Before reporting a catheterization code, be sure the service isn't included in a more comprehensive code for the same encounter. For instance, new-for-2012 renal angiography codes 36251-36254 and the revascularization codes introduced in 2011 (37220-37235) include catheterization, so you shouldn't report additional codes for catheterization.