Ask Dr. Z

We are wanting to know if a catheter placement into the aorta from the SMA that was accessed with an arteriotomy by an abdominal incision is separately billable. The op note states in part: "An upper midline laparotomy incision is performed in the usual fashion… A small transverse arteriotomy was made on the anterior surface of the SMA. Next the micropuncture wire is inserted directly into the arteriotomy site followed by a micropuncture sheath… The SMA lesion was crossed retrograde. The sheath was upsized to a short 7 French sheath. Given the poor distal outflow is difficult to opacify the runoff however the heavily calcified ostial lesion is easily visible in a steep oblique angle. A flush catheter was placed into the aortic to confirm reentry into the true lumen. The SMA lesion was pre-dilated with a 5 x 40 mm angioplasty balloon over the stiff Glidewire. Next a 7 by 27mm VBX is deployed at the SMA origin with excellent angiographic result." Would the cath placement be billed with 36200 or be considered part of the primary procedure?