How To Use CPT Code 36218

CPT 36218 describes the placement of a selective catheter into an additional second, third, or smaller order thoracic or brachiocephalic branch within a vascular family. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36218?

CPT 36218 can be used to describe the placement of a selective catheter into an additional second, third, or smaller order thoracic or brachiocephalic branch within a vascular family. This code is used when the provider needs to perform angiography of these arteries and it is done in addition to the primary selective catheterization.

2. Official Description

The official description of CPT code 36218 is: ‘Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)’

3. Procedure

1. The provider gains access to the blood vessels, typically through the femoral artery.
2. A small incision is made in the skin at the point of access, and a guidewire is placed through a sheath.
3. A catheter is inserted into an artery and guided through the arteries to the area of focus.
4. Contrast material is injected through the catheter, and X-ray and/or fluoroscopic images are taken to visualize the blood vessels.

4. Qualifying circumstances

Patients eligible to receive CPT 36218 services are those who require angiography of additional second, third, or smaller order thoracic or brachiocephalic branches within a vascular family. The procedure must be performed in conjunction with the primary selective catheterization. It is important to note that CPT 36218 should not be reported with nonselective catheter placement codes or certain other codes related to angiography and transcatheter therapies.

5. When to use CPT code 36218

CPT code 36218 should be used when the provider needs to perform angiography of additional second, third, or smaller order thoracic or brachiocephalic branches within a vascular family. It is important to ensure that the procedure is performed in addition to the primary selective catheterization.

6. Documentation requirements

To support a claim for CPT 36218, the provider must document the following information:

• Point(s) of access where the sheath has been placed
• Approach used (ipsilateral or contralateral)
• Point(s) of the highest level where the catheter was manipulated
• Imaging studies performed
• Each vascular family and access coded separately
• Additional second or third order catheterizations within a family
• Additional imaging studies within a family above the basic examination

7. Billing guidelines

When billing for CPT 36218, ensure that the procedure is performed in addition to the primary selective catheterization. It is important to follow the specific guidelines for reporting CPT 36218 and to avoid reporting it with nonselective catheter placement codes or certain other codes related to angiography and transcatheter therapies. It is also important to code all imaging studies performed and to code each vascular family and access separately.

8. Historical information

CPT 36218 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Examples

1. A cardiologist performing angiography of an additional second order thoracic branch within a vascular family in addition to the primary selective catheterization.
2. An interventional radiologist performing angiography of a third order brachiocephalic branch within a vascular family in addition to the primary selective catheterization.
3. A vascular surgeon performing angiography of a smaller order thoracic branch within a vascular family in addition to the primary selective catheterization.
4. An interventional neuroradiologist performing angiography of an additional second order thoracic branch within a vascular family in addition to the primary selective catheterization.
5. An interventional cardiologist performing angiography of a third order brachiocephalic branch within a vascular family in addition to the primary selective catheterization.
6. A vascular surgeon performing angiography of a smaller order thoracic branch within a vascular family in addition to the primary selective catheterization.
7. An interventional radiologist performing angiography of an additional second order thoracic branch within a vascular family in addition to the primary selective catheterization.
8. An interventional neuroradiologist performing angiography of a third order brachiocephalic branch within a vascular family in addition to the primary selective catheterization.
9. A vascular surgeon performing angiography of a smaller order thoracic branch within a vascular family in addition to the primary selective catheterization.
10. An interventional cardiologist performing angiography of a third order brachiocephalic branch within a vascular family in addition to the primary selective catheterization.