Difference between Selective and Non-selective catheterization

In interventional radiology coding, most of the medical coder get confuse with selective and non selective catheterization. Since minimal invasive procedure, are divided into two-part vascular and non-vascular procedure. Non-Vascular procedure are little easy to code compared with Vascular Procedure. Non-vascular procedure are direct codes like for biopsy, injection etc. Vascular procedure are typical to code and has certain rules to follow.

Vascular Family plays a key role to code vascular coding. Selective and non-selective catheterization concept can be clearly understood if one understand vascular family. Now, to code vascular procedure few thing has to remember

Selective and Non-selective catheterization coding rules

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Rules to follow for Selective and Non-selective catheterization

  1. Code Selective over non-selective catheterization

    Selective catheterization is consider when the catheter moves beyond the aorta. If the catheter stays in the aorta it is considered as non-selective catheterization. So, when the catheter enter into an artery it has to pass through the aorta to enter any of the vascular family. So, when the catheter is placed any of the selective artery of the vascular family, then one has to code the order of that artery. Hence, when you code a selective catheterization code the non-selective catheterization code get included automatically.

    For example, if we took an access and moves the catheter to aorta. So, till aorta it is considered non-selective catheterization. Once, the catheter moves beyond or away from aorta and enter into the vascular family, then the selected artery is coded as selective catheterization code.

    Read also: coding tips for Selective and Non-Selective Venous catheter placement

  2. Code each vascular family separately

    since there are separate vascular family, depending of different anatomic location. So, we have vascular family for upper extremity, pelvic region and lower extremity. When we code selective catheter placement, each time to enter into a vascular family the catheter has to pass through aorta, so hence we have to give separate code for each vascular family.


    For example, if the catheter has to enter into upper extremity family first it has to pass through aorta. Now, if you have to study low extremity as well, then the catheter has to again move from upper extremity to lower extremity. Now, when it moves from upper to lower region the catheter again passes through aorta, so we have to give another code for the second vascular family.

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  3. Code the highest order per vascular family

    This is very easy to understand. Since, we are inside a vascular family, the selective catheter placement should be coded of highest order. Since, the highest order is 3rd order, so if the catheter is placed in 1st, 2nd and 3rd order of the arteries. The highest 3rd order code will be enough to code in such cases since the 1st and 2nd order gets included with 3rd order code.

    For example, if we have 1st order artery (36245), second order artery(36246) and third order artery (36247) studied of same vascular family. In this situation, the third order artery code 36247 will be enough to code, since 36245 and 36246 gets included in 36247 of same family.

    Read also: Coding tips for Peripheral Angiography CPT codes

  4. Code each access separately

    whenever we have study a particular artery one has to take separate access. Separate access means we have to start from the beginning the whole procedure. Each access cost the same amount of time and cost. Hence, for each access we have to code separately.

    For example, if the physician studies an artery of upper extremity and artery of lower extremity, then he has to take separate access to study both field, hence they should be coded separately.

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  5. When to use 59 modifier in selective and non-selective catheterization

    Suppose, the physician studies an artery of lower extremity. The code for the studied artery is 36237, 3rd order artery. Now, after the procedure the physician again with the separate access studies an artery within same family. This time he chooses second order artery 36246. Now, we cannot code these 36247 and 36246 together, since 36246 is included in 36247. So, to show they are distinct procedures we have to give 59 modifier to 36246. So, like this we have to be alert when and to which code we have to give 59 modifier.

    Hope, you can code selective and non-selective catheterization procedures comfortably after reading this article. Please share if you liked the article.