How to code the selective catherization
For selective catheterization, the coder must determine how many vascular families were involved. Vascular families are defined by the vessels that arise directly off the aorta or vessel punctured. For instance, the innominate defines one particular vascular family. Within that family, you will find the right common carotid, the right subclavian, the right vertebral, and all other arteries that branch off of those, including all the arteries of the right arm. Once the catheter is moved beyond the accessed vessel without going into the aorta or into the aorta and moved further, the catheterization is considered selective. The catheter must move into a vessel and not just the ostium. Think of it as going into a room – not just standing in the doorway but actually entering the space. The correct Medical Coding Training helps to understand the concepts in detail.
Selective arterial catheterization codes include the following: 36215, 36216, and 36217 for arteries above the diaphragm; 36245, 36246, and 36247 for arteries below the diaphragm and second and additional catheterizations in a given family are coded with 36218 and 36248 because the first, second, and third order codes can only be used once within any one vascular family.
Selective catheterization codes are determined by how far they are from the aorta or the vessel catheterized. First-order catheterization codes 36215 and 36245 are used when the catheter only goes into an artery that comes directly off the aorta or vessel catheterized. Think of it as a road trip - you turn off Main Street (the aorta) onto First Avenue (the first-order vessel) and park. The most common first-order vessels above the diaphragm are the innominate, also called the brachiocephalic, left common carotid, and subclavian arteries. Below the diaphragm, the most common are the left and right renal, celiac, superior and inferior mesenteric arteries, and the left and right common iliac arteries.
Say you get back into the car and continue down First Avenue until you turn right onto Second Street, where you park again. Vessels that arise off of first-order vessels are second-order vessels. To get to these vessels, you must go through two others – the aorta, or vessel punctured, and the first-order vessel. Above the diaphragm, second-order codes 36216 and 36246 are coded most often for catheterization of the right subclavian or right common carotid (from the innominate), left internal carotid (from the left common carotid), and left vertebral arteries (from the left subclavian).