help with cardilology coding question


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The physician may need to puncture both femoral arteries. For instance, on one side he places the catheter into the aorta for an aortogram but cannot advance the catheter over the aortic bifurcation. He punctures the other femoral artery and places the catheter in the popliteal artery.

In this situation, you can code both catheter placements. You should report 36246 (Selective catheter placement, arterial system; initial second-order abdominal, pelvic or lower-extremity artery branch, within a vascular family) for the ipsilateral second-order catheter placement in the popliteal, and bill 36200 (Introduction of catheter, aorta) for the catheter to the aorta, she says. “This is one case where you can bill a nonselective cath placement, as well as a selective one, because there are two puncture sites.”


Question : How do they determine, it is a second-order,how do they com up with 36246. I am new to this . HOw do we determine is it second order or third order if they dont mention in the question. Thanks in advance