INTERVENTIONAL RADIOLOGY - INTRODUCTION

INTERVENTIONAL  RADIOLOGY

INTRODUCTION:

1.  INTERVENTIONAL RADIOLOGY is a medical sub specialty of Radiology that uses minimally invasive image-guided procedures to diagnosis and treat diseases in nearly every organ system.

    Classified into Vascular procedures and non vascular procedures.   

CPT’s: TWO COMPONENTS

1  SURGICAL CODES – Describe the work of actually performing the intervention such as inserting catheters or needles, inflating balloons, deploying stents, etc.

2  RADIOLOGICAL S&I CODES - Describe the work of taking x rays, performing image guidance, and the processing and interpreting of the images. 

VASCULAR PROCEDURES –TYPES

1  NON SELECTIVE PROCEDURES

       When the catheter stays in the vessel entered or only advances to the aorta. 

2  SELECTIVE PROCEDURES

      When the catheter advances from the vessel entered or from the aorta into a branch vessel.

INCLUSIVE:

1  Regardless of the approach (arm/leg) once the aorta is entered and a branch is selected – a selective catheter placement code must be used and the non-selective catheter position is included.

2  If you had to go through a section of a vessel to get to a more selective vessel the catheter placement in the initial vessel is included in the higher order selection as well as non selective placement.

EG:  3^rd order includes 2^nd and 1^st order as well as non selective placement.

SAMPLE CHART

A catheter is placed in the right femoral artery, it is advanced to the abdominal aorta(36200) contrast is injected, and imaging of the abdominal aorta is performed(75625) the catheter is advanced into the left common iliac artery(36245) and images taken of the entire left lower extremity of the foot (75710). The catheter is then advanced into the left superficial femoral artery (36247) and additional images are obtained to further evaluate the Tibial vessels (75774)

  36247- (Left superficial femoral artery) (Final placement includes lesser first order selection 36245 and non-selective 36200)

  75625-(Abdominal aorta), 75710 (Unilateral extremity) 75774 (for the additional selective imaging of the Tibial vessels)   

2 access site:

A sheath and guidewire are placed in the right femoral artery (36140). The guidewire will not advance to the aorta. An injection of the right femoral artery through the sheath is performed showing occlusion of the right common iliac. Right leg runoff angio is then completed. The right side is abandoned and access is gained through the left femoral artery. The catheter is advanced into the abdominal aorta at the L2 level (36200). Contrast is injected, and imaging of the abdominal aorta is performed (75625). The catheter is pulled down to L4 and left leg runoff done (75716).

  36140-59(right sided access), 36200(left sided access)

  75625 (abdominal aorta), 75716(Bilateral runoff)

ADD ON CODES:

There are 2 codes that describe the coding of each additional second order, third order, and beyond selective catheter placement in the same vascular family. 36218 and 36248.

As vessels are get more selective each lower level is passed through is included in the final destination.

Some vessels can only be selected by pulling the catheter back and going a different route in the same vascular family.  This is where additional second or higher selective catheter position codes 36218 & 36248 apply. 

SAMPLE CHART:

A catheter is placed in the right femoral artery. It is advanced to the high abdominal aorta, and an aortogram is performed (36200, 75625). The catheter is advanced into the common hepatic artery for additional selective imaging (add 36246, 75774) the catheter is withdrawn from the common hepatic artery and placed in the splenic artery for additional selective imaging (36248, 75774).

  36246 (Common hepatic), 36248 (splenic)

  75726 (Celiac), 75774 (Common hepatic), 75774(splenic) 

                 

DO AND DON’T

  Do code to where the tip of the catheter is.

  Do code each individual vascular family separately with the same rules using- 59 modifiers as necessary.

  Do code each approach from a different access site separately.

  Do code the aorta placement (36200) instead of other non-selective codes if the aorta has been entered.   

  Do use code 36251-36254 for unilateral or bilateral selective or superselective renal angiography. These codes include catheter placements, renal S&I, accessory renal catheter placements and S&I, non-selective abdominal aortography, 3D reconstructions and pressure gradient if obtained.

  Do use codes 36222- 36228 for selective or superselective cervicocerebral angiography. These codes include catheter placements, cervical carotid, cerebral carotid, vertebral, intracranial and external carotid supervision and interpretation, as well as non-selective arch aortography.

  Do not code imaging codes for injecting small amounts of contrast to localize a vessel for subsequent selection.

  Do not code the access site separately once a catheter through the sheath has reached the aorta or selected another vessel.