Welcome to the inaugural issue of the CodeMap Radiology Briefing. As many of you know, CodeMap has published a Compliance Briefing for diagnostic providers for over six years. However, a majority of the content of that communication was directed to laboratory and pathology providers. That's why we decided to launch a new briefing focused entirely on the Medicare coding, reimbursement, and coverage requirements that pertain to radiology providers. Rather than merely reporting on every new rule and policy change concerning Medicare coding and reimbursement, we will try to explain both new rules and existing issues in terms of what they mean to you, the radiology and imaging provider. Our goal will be to make sure you know how to comply with all rules and regulations, minimize the risks of non-compliance, and still receive accurate and complete reimbursement for the services you provide to Medicare and Medicaid patients.
In order to better serve our radiology provider subscribers, we are also pleased to announce the addition of a new contributing author, Ms. Stacie L. Buck. Ms. Buck, RHIA, CCS-P, LHRM, RCC, CIC, has 16 years experience in the health care industry. During her career she has served as an internal auditor and corporate compliance officer for one of the nation’s largest providers of diagnostic imaging services and has also provided consulting services to radiology practices. She is a nationally sought out speaker and author on radiology coding and reimbursement topics and serves on the editorial advisory board of several national radiology publications.
We welcome Ms. Buck, as well as those of you that may not yet be familiar with CodeMap. We hope this new email briefing is helpful and informative and invite all our subscribers to submit any comments, questions, or suggestions via email.
Many of our subscribers have inquired about resources for learning interventional radiology coding. In response to these inquiries, we will offer a series of short articles on interventional radiology procedures, starting with the basics and working our way through instruction on various interventional procedures. We hope that this series will meet the needs for those of you just starting out on your IR journey or for those who simply need a refresher.
Interventional Radiology Coding: Key Terms
To fully grasp the nuances of interventional radiology coding, one must have a clear understanding of the terminology utilized in coding for these procedures. This article will discuss those key terms that are the foundation for all interventional procedures.
Access: The first piece of the puzzle in determining the catheterization codes that should be assigned for a particular case is the point of access. It will be a key factor in whether a non-selective or selective catheter placement code is assigned, as well as determining vessel order.
Access for most interventional radiology procedures is gained via the axillary/brachial artery or vein in the upper extremity or via the common femoral artery or vein in the lower extremity, with the majority of procedures performed via the common femoral.
Vascular Family: A vascular family is a group of arteries (or veins) which arise from a primary branch of the aorta (or vena cava), or the vessel that is punctured.
The number of vascular families and the specific vascular families catheterized will also determine how many catheterization codes are assigned for a particular procedure. If multiple vascular families are catheterized, each vascular family is coded separately.
Vascular Order: Vascular order refers to the branching pattern of a vascular family. First order branches arise from the aorta (or vena cava), or the vessel that is punctured. Second order branches arise from first order branches and third order branches arise from second order branches.
Non-Selective Catheterization: Nonselective catheter placement means the catheter is placed directly into an artery (or vein) and is not advanced further into a branch or is advanced only into the aorta (or vena cava) from any approach.
Selective Catheterization: Selective catheter placement means that the catheter is advanced beyond the vessel punctured or beyond the aorta or vena cava into a vascular family. Selective catheterization involves first, second, and third order or higher degree vessels.
Ipsilateral: The term ipsilateral refers to the same side. For interventional procedures the term ipsilateral indicates that the intervention is being performed on the same side of the body as the point of access.
Contralateral: The term contralateral refers to the opposite side. For interventional procedures the term contralateral indicates that the intervention is being performed on the opposite of the body as the point of access.
Antegrade: The term antegrade means moving in the same direction of blood flow.
Retrograde: The term retrograde means moving backward or against the flow of blood.
Example 1:Access is gained at the right common femoral artery. The physician advances the catheter to the aorta, injects contrast and provides an interpretation for an abdominal aortogram.
This example demonstrates non-selective catheterization (36200). The catheter was advanced to the aorta and was not manipulated any further.
Example 2:Access is gained at the right common femoral artery. The physician injects contrast at the distal end of the common femoral and provides an interpretation for an extremity angiogram.
This example demonstrates a non-selective catheterization (36140). The catheter remained in the common femoral after access was gained into the vessel.
Example 3:Access is gained at the right common femoral artery. The physician advances the catheter to the aorta, injects contrast and provides an interpretation for an abdominal aortogram, then advances the catheter into the left common carotid for injection and imaging.
This example demonstrates selective catheterization of a first order vessel (36215). The physician advanced the catheter beyond the aorta and placed the catheter into the left common carotid, a first order branch off of the aorta.
Example 4:Access is gained at the right common femoral artery. The physician advances the catheter in an ipsilateral antegrade fashion to the superficial femoral, injects contrast and provides an interpretation for an extremity angiogram.
This example demonstrates selective catheterization of a first order vessel (36245). The physician manipulated the catheter beyond the vessel punctured, the common femoral, and placed the catheter into the superficial femoral a first order branch off of the common femoral. "Ipsilateral antegrade" tells the coder that the catheter remained on the same side as the point of access.
Example 5: Access is gained at the right common femoral artery. The physician advances the catheter in a contralateral retrograde fashion to the left external iliac, injects contrast and provides an interpretation for an extremity angiogram.
This example demonstrates selective catheterization of a second order vessel (36246). The physician manipulated the catheter through the aorta and the common iliac into the external iliac on the left side of the body. The external iliac on the opposite side is a second order vessel which branches from the common iliac, a first order vessel off the aorta. "Contralateral retrograde" tells the coder that the catheter was advanced through the aorta into the opposite side of the body.
Example 6: Access is gained at the right common femoral artery. The physician advances the catheter to the left common carotid for injection and imaging. Next he advances the catheter into the left subclavian for injection and imaging and finally to the right common carotid for injection and imaging.
This example demonstrates selective catheterization of multiple vascular families, therefore there will be three catheterization codes assigned for this case: 36215, 36215-59, 36216. (We will discuss modifier use in future issues)
Catheterization of the left common carotid, a primary (first order) branch off the aorta is 36215, catheterization of the left subclavian, a separate primary (first order) branch off the aorta is 36215, and catheterization of the right common carotid, a second order branch off the aorta is 36216.
In our next issue we will discuss the coding rules for the catheterization codes in more detail.