How To Use CPT Code 36252

CPT 36252 describes the selective catheter placement for renal angiography, including arterial puncture and catheter placement, fluoroscopy, contrast injection, image postprocessing, and radiological supervision and interpretation. 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 36252?

CPT 36252 can be used to describe the selective catheter placement for renal angiography. This procedure involves inserting a catheter into the artery at the groin level and maneuvering it to inject a dye into the main renal artery and any accessory renal artery(s). The purpose of this procedure is to visualize the renal blood vessels and investigate for any blockage, narrowing, or clots in the renal blood vessels.

2. Official Description

The official description of CPT code 36252 is: ‘Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral.’

3. Procedure

1. The provider assesses the patient’s condition and determines the need for renal angiography.
2. The provider inserts a catheter into the artery at the groin level and maneuvers it to the main renal artery and any accessory renal artery(s).
3. The provider injects a dye into the artery through the catheter and takes successive X-ray images as the dye moves through the renal blood vessels.
4. The provider may perform pressure gradient measurements to study the blood pressure at the renal artery versus the simultaneous blood pressure within the aorta.
5. If necessary, the provider may perform a flush aortogram by advancing the catheter to the aorta and identifying any possible abnormalities in the X-ray images after giving contrast.
6. The provider removes the catheter and applies pressure to the puncture site to stop bleeding.

4. Qualifying circumstances

CPT 36252 is performed on patients who require renal angiography to investigate for blockage, narrowing, or clots in the renal blood vessels. The procedure is typically performed bilaterally, meaning on both sides of the body. It is important to ensure that the patient does not have any existing bleeding problems or pregnancy before performing the procedure.

5. When to use CPT code 36252

CPT code 36252 should be used when the provider performs selective catheter placement for renal angiography, including arterial puncture and catheter placement, fluoroscopy, contrast injection, image postprocessing, and radiological supervision and interpretation. This code is specifically used for bilateral procedures, meaning it is performed on both sides of the body.

6. Documentation requirements

To support a claim for CPT 36252, the provider must document the following information:

• Indication for renal angiography
• Details of the catheter placement, including the specific arteries accessed
• Description of the fluoroscopy, contrast injection, and image postprocessing
• Permanent recording of images
• Radiological supervision and interpretation
• Pressure gradient measurements, if performed
• Flush aortogram, if performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 36252, ensure that the procedure meets the criteria for selective catheter placement for renal angiography, including all the necessary components such as arterial puncture, catheter placement, fluoroscopy, contrast injection, image postprocessing, and radiological supervision and interpretation. It is important to note that CPT 36252 is a bilateral code, so it should not be reported in conjunction with bilateral superselective code 36254.

8. Historical information

CPT 36252 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes bilateral renal angiography to investigate for possible blockage in the renal blood vessels.
2. A provider performs selective catheter placement for renal angiography on both sides of the body to visualize the renal blood vessels and assess for any narrowing or clots.
3. A patient with suspected renal artery stenosis undergoes bilateral renal angiography to evaluate the condition of the renal blood vessels.
4. A provider performs selective catheter placement for renal angiography on a patient with uncontrolled hypertension to assess for any abnormalities in the renal blood vessels.
5. A patient with a history of renal artery thrombosis undergoes bilateral renal angiography to check for any recurrence or new clots in the renal blood vessels.
6. A provider performs selective catheter placement for renal angiography on a patient with chronic kidney disease to investigate the cause of the condition.
7. A patient with renal artery aneurysm undergoes bilateral renal angiography to assess the size and location of the aneurysm.