Radiology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Our interventionalist performed angiograms on both the left and right carotid arteries to confirm the presence of a suspected occlusion. He initially introduced the catheter into the femoral artery and advanced it to the right internal carotid artery. Then, because he wanted to assess the left branch, he retracted the catheter from the right side and subsequently advanced it into the left internal carotid artery. How should we code this scenario?

Texas Subscriber

        Answer: This is a prime example of the importance of understanding selective catheterization, as well as using several modifiers.
 
Catheterization on the right side should be reported with CPT 36217 (selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family) because the catheter was advanced to a third-order branch from the initial access point at the femoral artery. A modifier to indicate that this was performed on the right side (e.g., -RT) may need to be appended, depending on payer policy.
 
In addition, 36216 (selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family) would be assigned to describe catheterization on the left side because that procedure reflects second-order catheterization. An -LT modifier could also be used to indicate catheterization was on the left side.
 
Note: Because the code for the left side is different from the right side, 36216 versus 37217, it is not appropriate to use modifier -50 (bilateral procedure).
 
Coders may be required to append modifier -59 (distinct procedural service) to the second code (36216). The Correct Coding Initiative edits do not allow 36217 and 36216 to be reported together unless they are separate and distinct services. However, because the two catheterizations were conducted in two separate vascular families, they both may be assigned in this case. Some payers will require the use of modifier -59 to confirm that entirely different services were provided. Other payers may find the -RT and -LT indicators adequate. Coders should check with the insurer in question to determine appropriate coding.