When coding angiography procedures, you must clearly understand three important things from the medical documentation.
1. Site of Access (Where the Doctor Started)
The access site is the location where the doctor inserts the needle or catheter to begin the procedure.
Common access sites include:
Femoral artery (groin)
Brachial artery (arm)
Radial artery (wrist)
Jugular vein (neck)
The starting point matters because it affects how we determine the level of catheter selection.
Example
If the doctor enters through the groin (femoral artery) and moves the catheter to the right axillary artery, the pathway is:
Femoral artery → Aorta → Brachiocephalic artery → Subclavian/Axillary artery
This is considered Second-Order Selection.
But if the doctor starts from the right brachial artery (arm) and reaches the axillary artery, it is Non-Selective because the catheter is already very close to the target vessel.
Important Coding Rule
The access site itself is NOT coded separately unless the catheter does not move from that location.
Also remember this rule:
Never code both puncture site and catheter placement separately for the same access.
2. Vessels Selected and Imaged
When coding angiography, you must identify:
• Which vessels the doctor entered with the catheter
• Which vessels were imaged with contrast
• Which vessels have documented interpretation
Key Rule
Only code imaging when:
✔ Contrast was injected
✔ Permanent images were taken
✔ The physician documented interpretation
If a vessel is only seen but no images were saved, do not code it.
Imaging supervision and interpretation codes come from the 70000 CPT section.
Selective Imaging Requirement
If the CPT code description includes words like:
Selective
Supraselective
Example codes:
75736
Then documentation must show that the catheter was actually moved into that vessel before injecting contrast.
3. Vascular Anomalies (Unusual Vessel Anatomy)
Sometimes a patient’s blood vessels are arranged differently than normal. These are called vascular anomalies.
A common example is a:
Replaced Right Hepatic Artery
Normally:
The right hepatic artery branches from the celiac artery
But in some patients:
It comes from the Superior Mesenteric Artery (SMA)
This changes the level of catheter selection.
For example:
Normally → Third-order vessel
With anomaly → Second-order vessel
So coders must carefully review anatomy before assigning catheterization codes.
Catheterization Coding Basics
Catheterization codes include the following services automatically:
✔ Local anesthesia
✔ Needle insertion
✔ Catheter placement
✔ Contrast injection
✔ Pre-injection and post-injection care
So do NOT code these separately.
Important Catheter Coding Rule
If a selective catheterization is performed, the non-selective code is no longer reported.
Always follow this rule:
Code the highest level of catheter selection in each vascular family.
If additional branches are selected in the arterial system, they may be coded separately.
Venous Non-Selective Catheterization Codes
These codes are used when the catheter is not moved into specific branch veins.
CPT 36000
Introduction of needle or catheter into a vein.
Used when:
A catheter is inserted into a vein
No further selection is done
Example:
Contrast injection into the jugular vein for venography.
CPT 36005
Injection for extremity venography.
This code includes:
Needle insertion
Catheter placement
Contrast injection
Important rule:
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This code can only be used for extremity venography and not for other procedures.
CPT 36010
Catheter placement into the Superior Vena Cava (SVC) or Inferior Vena Cava (IVC).
Use this code when:
The catheter ends in SVC or IVC
No additional veins are selected.
Note:
Some procedures (like vena cava filter placement) already include catheterization, so always check CPT guidelines before using 36010.
CPT 36481
Percutaneous catheterization of the portal vein.
This is a special exception rule.
Normally:
When selective catheterization occurs, non-selective codes are removed.
But in this case:
You can still code 36481 even if additional portal branches are selected.
If additional veins are catheterized:
36011
36012
may also be reported.
Venous Selective Catheterization Codes
In the venous system there are only two levels of selection.
CPT 36011
Selective catheter placement into first-order veins
Examples:
Renal vein
Jugular vein
CPT 36012
Selective catheter placement into second-order or higher veins
Examples:
Left adrenal vein
Petrosal sinus
Important rule:
Even if multiple second-order veins are selected in the same vascular family, each one can still be coded using 36012.
Arterial Non-Selective Catheterization Codes
These are used when the catheter remains in a main artery without selecting branches.
CPT 36013
Catheter placement into the right heart or main pulmonary artery.
This is used for pulmonary angiography when the procedure is not performed with coronary angiography.
How the catheter reaches the heart:
Femoral vein → Inferior vena cava → Right atrium → Pulmonary artery
Important:
Do not report 36013 with certain pulmonary nerve ablation procedures.
CPT 36100
Direct puncture of the carotid or vertebral artery.
Used when:
The artery is accessed directly with a needle for angiography.
CPT 36140
Catheter or needle insertion into an extremity artery.
This applies to:
Arm arteries
Leg arteries
Use this code only if the catheter is not advanced further into other arteries.
CPT 36160
Direct translumbar access to the aorta.
In this technique:
The needle is inserted through the back directly into the aorta.
This is often used to check for endoleaks after aortic aneurysm stent graft repair.
Why it is needed:
Standard angiography from inside the stent may not show leaks outside the graft, but translumbar access can reveal them.
CPT 36200
Non-selective catheter placement in the aorta.
Use this code when:
A catheter is moved into the aorta
No branch arteries are selected.
Important rules:
• Report 36200 only once even if the catheter is repositioned in different parts of the aorta.
• Do not report 36200 with cardiac catheterization procedures that include an abdominal aortogram.
Arterial Selective Catheterization
Arterial selective catheterization codes are grouped into:
Above the diaphragm
Below the diaphragm
Pulmonary arteries
Pulmonary Artery Selective Codes
CPT 36014
Selective catheterization of the right or left pulmonary artery.
If both arteries are catheterized:
You can report 36014 twice.
CPT 36015
Selective catheterization of segmental or subsegmental pulmonary arteries.
This represents a higher level of selection than 36014.
Important rule:
Code 36015 already includes catheterization through the right or left pulmonary artery, so do not report 36014 and 36015 together for the same lung.
Also do not report these codes with pulmonary artery nerve ablation procedures.
Beginner Tip for Angiography Coding
Always identify three key things in the operative report:
1️⃣ Where the catheter started (access site)
2️⃣ Which vessels the catheter entered (selection level)
3️⃣ Which vessels were imaged and interpreted
If you understand these three points, angiography coding becomes much easier.