How To Use CPT Code 36254

CPT 36254 describes the procedure of superselective catheter placement for renal angiography. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36254?

CPT 36254 is a code used to describe the procedure of superselective catheter placement for renal angiography. This procedure involves the insertion of a catheter into the artery at the groin level and maneuvering it to inject a dye into the second or higher order subdivisions of the main renal arteries that supply both kidneys. The purpose of this procedure is to visualize the renal blood vessels and investigate any blockage, narrowing, or clots in these vessels.

2. Official Description

The official description of CPT code 36254 is: ‘Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, 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 eligibility for the procedure and ensures there are no existing bleeding problems or pregnancy.
2. The patient is appropriately prepped and anesthetized.
3. The provider inserts a needle into the femoral artery at the groin level and passes a thin long flexible guide wire and small fine catheter into the artery.
4. The provider connects the catheter to a fluoroscope, which sends X-ray images to a display monitor.
5. With the help of fluoroscopic guidance, the provider gently pushes the catheter up to the second or higher order branches of the renal artery.
6. The provider injects a dye into the artery through the catheter and takes successive X-ray images as the dye moves through the blood vessels.
7. The provider may perform pressure gradient measurements using a pressure guide wire to study the blood pressure at the renal artery.
8. If necessary, the provider may perform a flush aortogram by advancing the catheter to the aorta and identifying any abnormalities in the X-ray images.
9. The provider removes the catheter after taking the X-ray images and applies pressure to the puncture site to stop bleeding.

4. Qualifying circumstances

CPT 36254 is performed on patients who require renal angiography to investigate any blockage, narrowing, or clots in the renal blood vessels. The procedure is performed bilaterally, meaning it covers both sides of the body. It involves the placement of a catheter into the second or higher order branches of the renal artery and any accessory renal artery(s).

5. When to use CPT code 36254

CPT code 36254 should be used when the provider performs superselective catheter placement for renal angiography, specifically targeting the second or higher order branches of the renal artery and any accessory renal artery(s). This code should be used for bilateral procedures. It should not be reported in conjunction with bilateral first-order codes (such as CPT 36252).

6. Documentation requirements

To support a claim for CPT 36254, the provider must document the following information:

• Patient’s eligibility for the procedure
• Specific details of the procedure, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation
• Date and duration of the procedure
• Details of the catheter placement and dye injection
• Results of the procedure, including any pressure gradient measurements or flush aortogram if performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 36254, ensure that the procedure meets the criteria for superselective catheter placement for renal angiography. It should include all the necessary components, such as arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation. Do not report CPT 36254 in conjunction with bilateral first-order codes (such as CPT 36252). Additionally, do not report CPT 36254 in conjunction with codes 0338T and 0339T.

8. Historical information

CPT 36254 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 provider performs superselective catheter placement for renal angiography on a patient with suspected renal artery stenosis.
2. A patient with a history of renal artery thrombosis undergoes superselective catheter placement for renal angiography to assess the patency of the renal blood vessels.
3. A provider performs superselective catheter placement for renal angiography on a patient with uncontrolled hypertension to investigate any potential renal artery abnormalities.
4. A patient with chronic kidney disease undergoes superselective catheter placement for renal angiography to evaluate the renal blood flow.
5. A provider performs superselective catheter placement for renal angiography on a patient with recurrent urinary tract infections to assess the renal blood vessels for any underlying abnormalities.
6. A patient with a renal mass undergoes superselective catheter placement for renal angiography to determine the blood supply to the mass.