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Diagnostic Angiography and Revascularization of Lower Extremity

The Catheterization is divided into two types and there are, 

  • Non Selective Catheter Placement
  • Selective Catheter Placement

Non Selective Catheter Placement

  • The non selective catheter placement is not to be coded with selective catheter placement together. 
  • And the following to be considered as non selective catheter placement, puncture of catheter, Insertion, and placement of catheter into the aorta. 
  • Also, if the catheter does not have any further movement it should be considered as non selective catheter placement.

E.g.,

When the documentation shows that the catheter placement was only in the aorta, the non-selective catheter placement CPT code 36200 is to be coded.

Selective Catheter Placement

  • The selective catheter placement is advanced from the original vessel of puncture sites to another vessels and it should be considered as selective catheter placement.
  • When the catheter is advanced and/or crossed from the aorta and it should be considered as selective catheter placement.

E.g., 

Insertion of a catheter into the aorta is considered non-selective. The catheter can “enter” the aorta, but it is considered a non-selective vessel. When the documentation shows that the catheter placement was only in the aorta, the non-selective catheter placement CPT code 36200 is coded. Once the catheter is placed into a selective artery, the non-selective code is removed and bundled in with the highest of level selective catheter placement. (First order, Second order, Third order).

Tips

The documentation states the catheter placed into a 3rd order vascular family (CPT 36247), any non-selective codes (36200), first order (36245), and second order (36246) are considered as bundled with CPT 36247 on the ipsilateral side (same side as catheter placement).Only highest level of catheter placement can be coded for each insertion point. 

Guidelines

The lower extremity endovascular revascularization codes describing services performed for occlusive disease (37220-37235) include catheterization (36200, 36140, 36245-36248) in the work described by the codes. 

Catheterization codes are not additionally reported for diagnostic lower extremity angiography when performed through the same access site as the interventional procedures (37220-37235) performed in the same session. 

However, catheterization for the diagnostic lower extremity angiogram may be reported separately if a different arterial puncture site is necessary.

Diagnostic angiography and radiological supervision and interpretation codes should NOT be used with interventional procedures,

  • Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the intervention,
  • Vessel measurement, and
  • Post-angioplasty/stent/atherectomy angiography, as this work is captured in the radiological supervision and interpretation code(s). In those therapeutic codes that include radiological supervision and interpretation, this work is captured in the therapeutic code.

Diagnostic angiography performed at the time of an interventional procedure is separately reportable if,

  • No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR
  • A prior study is available, but as documented in the medical record:

    • The patient's condition with respect to the clinical indication has changed since the prior study, OR
    • There is inadequate visualization of the anatomy and/or pathology, OR
    • There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.

Diagnostic angiography performed at a separate sessions from an interventional procedure is separately reported.

Lower Extremity Vascular Family 

There are three vascular territories categorized for coding purposes in the lower extremities. There are,

  • Iliac territory - Which included of Common Iliac, Internal Iliac, and External Iliac arteries.
  • Femoral/Popliteal territory - Which has the common femoral, profunda femoral, superficial femoral, and popliteal arteries
  • Tibial/Peroneal territory -  Which includes the Anterior Tibial, Posterior Tibial, and Peroneal arteries.

There is a hierarchy that must be followed when reporting these interventions which is a stent with atherectomy supersedes atherectomy, which supersedes stent, which supersedes angioplasty when performed in the same vessel territory.

Note: Diagnostic angiography performed at the time of an interventional procedure is NOT separately reportable if it is specifically included in the interventional code descriptor.

Tips for Selecting the codes,




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