Ask Dr. Z

Dr. Z -- I would appreciate your interpretation of the procedure description below as to the code/charge for selective catheterization. “The 6-French sheath was placed in the right femoral artery. The right lower extremity angiography was performed through the sheath. Following this, the sheath was exchanged out for an AccessPro which was advanced TO THE CONTRALATERAL COMMON ILIAC.” (Angio findings are documented.) Then says, “An intervention was performed on the LEFT INTERNAL ILIAC. An 0.014 Stabilizer Plus WIRE was advanced out INTO THE INTERNAL ILIAC and balloon angioplasty…etc., etc.” (Stenting followed the angioplasty.) I do not have any problem with the procedure codes. However, as far as selectivity, should we code/charge 36245-LT (first order to common iliac) OR 36246-LT (second order to internal iliac)? Does the WIRE placement described above equal selective catheter placement? Is the "default" that the vessel is selectively engaged/cathed if it is treated?? MANY THANKS FOR YOUR ASSISTANCE!