Question:

How do you know when it is appropriate to report code 36218 for additional 2nd or 3rd order vessels selectively catheterized?

Answer:

The first question to ask is whether the vessel in question is in the same vascular family as other coded vessels. Then, the easiest way to determine whether it is appropriate to assign 36218 is to ask yourself: is the vessel that I’m questioning a vessel that I could only gain access to by passing through the other vessel I’m trying to code for? You can’t code for the vessels that are passed through to get to the final destination, so if the answer is yes then it would not be appropriate to use 36218. However, it is appropriate to report 36218 for additional catheter placements in the highest order of selectivity when you would not pass through one of those vessels to get to the other(s). For example, if the catheter is selectively placed in the left radial artery, the left ulnar artery, and the left interosseous artery – these are three separate vessels that are separately accessed (meaning the catheter needs to be pulled back to be placed in each) so it would be appropriate to report selective catheterization code 36217 for the first placement and then 36218 twice, one for each additional placement.

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