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A selective catheter placement procedure involves the introduction of a catheter into the arterial system, specifically targeting the thoracic or brachiocephalic branches within a single vascular family. This procedure is typically initiated by accessing an extremity artery, with the femoral artery being the preferred site for catheter insertion, although access can also be achieved through an upper extremity artery. The process begins with a small incision made at the chosen insertion site, followed by the placement of an introducer sheath into the artery. A guidewire is then inserted through the sheath, allowing for the advancement of the catheter into the aorta. The physician skillfully navigates the guidewire through the femoral and iliac arteries and into the aorta, subsequently advancing the catheter over the guidewire into the first-order branch of the thoracic or brachiocephalic region. The procedure continues as the physician selectively advances the catheter through higher-order branches—second, third, and beyond—until the catheter reaches the highest-order branch that requires evaluation. Once the catheter is properly positioned, the guidewire is removed, and the physician may perform an injection of medication or radiopaque contrast media as necessary to facilitate imaging or treatment. It is important to note that CPT® Code 36218 is specifically used for the catheterization of each additional second-, third-, or higher-order branch within the same vascular family, following the initial catheterization of a second or third-order vessel, which is coded separately.
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The selective catheter placement procedure is indicated for various clinical scenarios where detailed evaluation or intervention within the thoracic or brachiocephalic branches of the arterial system is necessary. The following conditions may warrant this procedure:
The selective catheter placement procedure involves several critical steps to ensure accurate positioning and evaluation of the vascular branches. The following procedural steps outline the process:
After the selective catheter placement procedure, appropriate post-procedure care is essential to ensure patient safety and recovery. Patients are typically monitored for any complications related to the access site, such as bleeding or hematoma formation. The site should be kept clean and dry, and patients may be advised to limit physical activity for a specified period to promote healing. Follow-up imaging may be required to assess the effectiveness of the procedure and to monitor for any potential complications. Additionally, the physician may provide specific instructions regarding medication management and any necessary follow-up appointments to ensure comprehensive care.
| Short Descr | PLACE CATHETER IN ARTERY | Medium Descr | SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 6 | CCS Clinical Classification | 54 - Other vascular catheterization, not heart |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 36216 | MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family | 36217 | MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family | 36225 | MPFS Status: Active Code APC Q2 ASC N1 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed | 36226 | MPFS Status: Active Code APC Q2 ASC N1 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed | 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) |
| XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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| 2017-01-01 | Changed | Guidelines changed. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Guideline information changed. |
| 1992-01-01 | Added | First appearance in code book in 1992. |
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