Medical nurse adjusting catheter

Non-selective and selective venous catheter device placement is a key area to master. First, remember that all procedural coding defining catheter placement, whether selective or nonselective, is determined by two main criteria:

  • The starting point (puncture site); and
  • The location of the final catheter placement in each vessel or vascular family accessed.

Let’s review some important rationale behind catheter/device placement.

Methods for Access Venous Procedures

Although there are multiple methods to gain access for venous procedures, two coding examples will be provided. Specifically, the assumed points of access will be via a femoral vein approach or an internal jugular vein approach. Note that both arterial and venous vascular coding is founded upon the starting and ending points. More importantly, arterial selective codes provide four options to choose from. These are the following codes:

  • 36215–36218
  • or 36245–36248

However, know that selective venous options are defined by only two coding choices 36011 and 36012.

36011Selective catheter placement, venous system, first order branch
36012Selective catheter placement, venous system, second order or more selective, branch

Since there are only two selective choices, any vessel accessed following catheter placement into a primary branch of the superior vena cava (SVC) and inferior vena cava (IVC) (such as renal veins) or any secondary branch of the primary branch of a vessel entered by a direct stick method (the straight sinus following direct puncture of the internal jugular vein) would be defined by code 36011.

What about the first order of selectivity? It is important to understand that any vessel beyond the first order of selectivity will be defined by code 36012. When is appropriate to use this code? 36012 should be used for each second-order vessel and beyond per separate branch of each vascular family studied.

When assigning codes for vessels accessed within the portal system, submit code 36481 (percutaneous portal vein catheterization by any method) in addition to codes 36011 or 36012.

Please refer to the following tables for venous vascular code options for the vessels listed.

Via a Right or Left Femoral Vein Stick
VEIN CATHETERIZED CORRECT CODE
Innominate/Brachiocephalic36011
Subclavian36012
Axillary36012
Internal jugular36012
External jugular36012
External iliac (ipsilateral)36005
Common iliac (ipsilateral)36005
IVC36010
Renal (main)36011
Right testicular/ovarian/gonadal36011
Left testicular/ovarian/gonadal36012
Right adrenal36011
Left adrenal36012
SVC36010
(All vessels distal to the internal and external jugular veins from a femoral vein approach would be coded as 36012.)
Via a Right or Left Internal Jugular Vein Stick
VEIN CATHETERIZED CORRECT CODE
Internal jugular (ipsilateral)36000
SVC36010
IVC36010
Renal (main)36011
Right testicular/ovarian/gonadal36011
Left testicular/ovarian/gonadal36012
Common iliac36011
External iliac36012
Deep femoral36012
Great saphenous36012
Portal System Via Right Internal Jugular Vein Stick
VEIN CATHETERIZED CORRECT CODE
SVC36010
Right hepatic36011
Branches of right hepatic36012
Portal36481
Splenic36011
Superior mesenteric36011
Inferior mesenteric36012
Ileocolic36012
Left colic36012
Right colic36012
Pancreaticoduodenal36012

These are not all the necessary coding tips and rationale essential for correct venous studies coding and compliance. As service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our Venous Studies Interventional Radiology Coding webcast is an essential training tool for both audio and visual learners.

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