General Surgery Coding Alert

Question: Please help with coding for the following scenario:

Surgeon entered the left brachial artery using a needle and Seldinger technique under fluoroscopic guidance, and catheterized the aortic arch and distally to each iliac and femoral artery. Performed arteriography using contrast, then de-catheterized, applying pressure on the brachial artery.

Delaware Subscriber

Answer: The correct code is 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family), because the common femoral artery is the most distal vessel catheterized in the procedure.

You should append modifier 50 (Bilateral procedure) because the surgeon documented catheterizing "each" iliac and femoral artery.

Look to Appendix L: CPT® provides a helpful coding tool in Appendix L --" a chart of the vascular families. The chart assigns branches to first, second, and third order, plus a listing of branches beyond third order.

When you're coding for selective catheterization, this table will answer your coding questions quite clearly, as long as you remember that you should code to the most distal vessel catheterized.

Caution: The Appendix L diagram assumes that the catheterization starting point is the aorta, so it will not be accurate for other starting points, such as an antegrade femoral artery catheterization.