IINTERVENTIONAL RADIOLOGY – Vascular Procedures

 Interventional Radiology – Vascular Procedures

                Vascular procedure consist of two major parts Surgical and Radiological S&I

First part: Surgical codes

      1.       Vascular access

      2.       Catheter placement

      3.       Interventions Š

Second part: Radiological supervision and interpretation

     1.       Imaging (guidance and images taken)

     2.       Interpretation of films

     3.       Physician must supervise and interpret to assign S&I codes.


In case physician performs only the S&I part alone - Append Modifier -52


In Medical Coding - Five vascular systems for interventional procedures:

         1.       Arterial

         2.       Venous

         3.       Pulmonary

         4.       Portal

         5.       Lymphatic


Components of IVR

         1.       Catheter insertion point Š

         2.       Catheter end point Š

         3.       Vessels catheterized Š

         4.       Vessels visualized Š

         5.       Abnormal anatomy findings

Access Site       

      1     Where physician enters the vascular system by puncturing a vessel Š

      2     Multiple access sites and their catheterizations are reported separately

Vascular Family

     Network of vessels that arise from a single branch from the aorta or vena cava

        Š  First Order - Vessel that is a primary branch off the aorta or vena cava Š

          Second Order - Vessel branching from a first order vessel Š

          Third Order - Vessel branching from a second order vessel

Non-Selective Catheterization - The catheter or needle is placed directly into an artery or vein (and not moved or manipulated further) or is placed only into the aorta (thoracic and/or abdominal) from any approach.

Selective Catheterization - Movement of the catheter into the arterial or venous system beyond the aorta or vena cava

Catheterization Coding Rules Š

                Code each vascular family to the highest order selected. Š

                Each vascular access is coded separately. Š

                Additional vascular families catheterized are coded separately.

                Each family is coded separately when two or more vascular families are catheterized.


Additional Branches in Same Family

                Only 1 initial catheter placement code can be reported per vascular family. Š

                Catheter may be pulled back and advanced into a different branch within the same family. Š

                Code (36218 or 36248) (36012) for the lower of the two placements in addition to the highest catheter placement code in the family  36218 and 36248 may be assigned multiple times.


Supervision & Interpretation Coding Š

               Contrast is injected for imaging of vessels Both unilateral and bilateral codes Š

                Some codes specify selective imaging Š

               S&I codes are assigned for each vessel studied Š


Modifiers usage Š

               Do not use modifier 50 or RT/LT with Vascular catheterization codes.

               Use modifier 59 to indicate separate vascular families. Š

               For S&I codes – RT/LT or 59 when applicable

Catheter Placement - Aorta

      1.       When catheter placement in aorta and contrast flows into lower extremities – runoff

               Assign CPT = 36200 and 75630 Š

      2.       When catheter placement in abdominal aorta and catheter repositioned in lower aorta for a lower extremity study

               Assign CPT = 36200, 75625, 75716

Example: Š


       Access: Femoral Artery then catheter advanced to aorta, contrast injected with imaging. Catheter advanced to the right common iliac, contrast injected with imaging of the right lower extremity and right internal iliac.

   36245 (R C Iliac)

   75625 (Aortogram)

   75710 (RLE) Š

    Access: Femoral Artery then catheter selectively advanced to the bilateral internal iliacs and bilateral uterine arteries with contrast injection and imaging.

     36247 (RUA)

     36247-59 (LUA)

     75736-RT (R Iliac)

     75774 (RUA)

     75774 (LUA)

     75736-LT (L Iliac)

    Access: Right Common Femoral then catheter advanced to the aorta, injection performed for aortogram. Catheter advanced to the left renal with injection an imaging, then advanced to the right renal with injection and imaging. SMA is selectively catheterized with injection and imaging.

       36245 (L Renal)

       36245-59 (R Renal)

       36245-59 (SMA)

       75724 (bilateral renal)

       75726 (SMA)


     Access: Right Common Femoral then catheter advanced to the aorta, injection performed for aortogram. Catheter advanced to the celiac with injection and imaging, then advanced to the right hepatic with injection and imaging, then advanced to the left hepatic with injection and imaging.

       36247 (R hepatic)

       36248 (L hepatic)

       75726 (Celiac)

       75774 (R hepatic)

       75774 (L hepatic)


Therapeutic Interventions:

     1.       Angioplasty

     2.       Stents Š

     3.       Atherectomy Š

     4.       Embolization Š

     5.       Thrombolysis Š

     6.       Thrombectomy Š

     7.       Dialysis Graft Declotting


NOTE:

Diagnostic angiography codes should not be used with interventional procedures for:

  Contrast injections, angiography, road mapping, and/or fluoroscopic guidance for the intervention,    Vessel measurement, and post-angioplasty/stent angiography as this work is captured in the interventional radiologic supervision and interpretation code(s).


Stent Placement

          Angioplasty performed solely to deploy a stent is not separately coded.


Atherectomy

           Report one Atherectomy per vessel

           Do not report an angioplasty when a positioning balloon is utilized for Atherectomy.


Embolization

           Embolization code is assigned once per operative field.