peripheral vascular coding

My question is about charging for a non-selective and selective cath in the same session. I don't think this can be done unless there are separate accesses in which case you would append a 59 modifier. I am being questioned about this and would appreciate any further information-
The following are two scenarios being presented to me:
#1
There should be no confusion about this. You most certainly CAN and SHOULD bill the non-selective AND selective catherization even when performed in the same encounter. The rule for billing the 'highest level' is applicable to selective catherization ONLY. For example if you do an abdominal aortogram and a 1st order angio then you bill ( and should get paid for both). However, if you do a 1st and 2nd order angio then you bill only for the 2nd order. Also all peripheral / vascular cases should also have an 'access' code either 36140 or 36200

#2
we place a non-selective cath in the aorto and do aortic angios 9with possible bilateral run-off, etc, and then we will place a selective cath in the first to third order vessel to do selective angio, I think billing both is legitimate if you do both, the hospital bills for both types of catheter placements

My training tells me only the selective cath can be billed regardless of the scenarios above-

Peripheral Vascular Coding

You are correct. If the physician places the catheter in the aorta and performs and aortogram 36200 & 75625-26 and then crosses over to the contralateral side (e.g. from right to left) and places the catheter in the common iliac (36245), the 36200 now gets dropped from the billing because the physician went beyond the basic study. That's why the NCCI bundles the 36200 into the 36245.

Yes modifier 59 could be placed on the 36200 to get it paid in additiona to the 36245, however that's not appropriate billing unless the catheter placement into the aorta was from a separate access site (e.g. 2 femoral punctures).

peripheral vascular coding

And what if the doctor goes on from the aortogram (where he has used a non-selective cath) and does a vascular stent using a selective cath- if this is in the same session I believe he still can't charge for both caths- is that your understanding as well?

Peripheral Vascular Coding

Yes, it is.

If the physician places a stent you drop the 36200 (aorta cath) and bill for the selective catheter placement where the stent was placed.

peripheral vascular coding

Thanks so much -this information has been very helpful!