Selective renal angiography (left lower renal artery) (Photo credit: Wikipedia)
Coding Selective catheterization of both renal arteries in medical coding
Renal arteries arise directly from the aorta. Renal arteries form a separate vascular family. Vascular families are coded always separately. When we code catheter placement code for renal arteries, we have separate CPT® codes. Selective catheterization of both renal arteries have a single CPT® code. This CPT® code includes everything from taking access to placing the catheter in the renal artery. These are actually new codes used mainly for renal artery catheterization.
CPT® codes for selective catheterization of both renal arteries
The CPT® codes used for coding renal arteries are 36251, 36252, 36253 and 36254. These CPT® codes include all the minor procedure required for catheter placement. The CPT® codes are allocated on the basis of branches of renal artery. So, the main renal artery and it branches have specific CPT® code. The main renal artery is stated as First order renal artery and its branches as second order. We don’t have the third order or any other code for higher order arteries. The main renal artery is given selective catheter placement code and it branches are given superselective catheter placement codes. The arteries of second order or of higher level will be coded second order CPT® Code. The CPT® codes used for first order renal arteries are 36251 and 36252. The CPT® codes used for second order or higher level of renal arteries are 36253 and 36254.
Procedures include in Selective catheterization of both renal arteries
The abdominal aortogram CPT® Code 75625 is included in selective catheterization of renal arteries. The code description states that it includes flush aortogram or abdominal aortogram. Also, the Fluoroscopic or ultrasound guidance codes are included in these CPT® codes. Supervision and interpretation codes are also include in these procedures. So, never code following codes with codes from 36251-36254.
75625- Abdominal aortogram
76937- Ultrasound guidance
77001-Fluoroscopic guidance
Also, conscious sedation is included in these CPT® codes. So, we do not codes conscious sedation separately with CPT® codes from 36251-36254.
Unilateral and bilateral selective catheterization of both renal arteries
The study which includes only selective catheterization of one side of main renal artery is code as 36251. Since, we have renal arteries on both the sides the CPT® codes are divided as unilateral and bilateral. Same, when the study of both sides of main renal arteries is done, the code used is 36252. Never, use a 50 modifier when we are coding these CPT® codes. This modifier denotes bilateral procedure. We have separate code for bilateral procedure so we can avoid using 50 modifier.
Coding for selective catheterization of both renal arteries branches
The renal arteries branches have separate code, 36253 and 36254. These branches come under second order catheterization codes. These codes are similar to CPT® codes for main renal arteries. These codes are used for any higher order or level of arteries. We cannot use first order codes with second order CPT® codes. The second order CPT® codes include the first order code. This is one of the rules for coding vascular families. Second order catheter placement is also stated as superselective catheter placement. They also have separate codes for unilateral and bilateral renal arteries. For unilateral second order renal artery catheter placement we use 36253 CPT® code. For bilateral second order renal artery we use 36254 CPT® code. Also, these procedures include all the minor procedures which are included with the first order CPT® codes.
Hope, now you can easily code catheter placement codes for renal arteries. Please share if you liked the article.
Author: jitendra az
