CPT Codes 36245–36248: Selective Catheterization Billing and Documentation
The report reads cleanly: access at the femoral artery, catheter through the aorta, into a first-order branch, then a second, then a third, with imaging at the end. The coder sees three levels of selection and wonders whether that is three codes. It is not. The catheter passed through vessels on the way, and only the highest order reached in a vascular family is reported.
Getting this right protects claim accuracy, reimbursement, and compliance. This guide explains the four codes, how vascular families work, what the operative report should establish, and where errors occur. Descriptors are paraphrased, so use the current CPT manual and Appendix L as the definitive source.
Quick Reference: CPT Codes 36245–36248
CPT | Selection level | General description | Initial or add-on | Key billing point |
36245 | First order | Selective placement in a first-order abdominal, pelvic, or lower-extremity artery branch | Initial | Reported when first order is the highest reached in the family |
36246 | Second order | Initial second-order placement in the family | Initial | Includes lower-order passage in that family |
36247 | Third order or higher | Initial third-order or more selective placement | Initial | Highest-order code replaces lower codes |
+36248 | Additional second, third, and beyond | Additional second-order or higher branch within the same family | Add-on | Listed with 36246 or 36247 only |
These codes cover abdominal, pelvic, and lower-extremity arteries. Selective arterial catheterization above the diaphragm uses 36215–36218, per AAPC guidance, and pulmonary arteries use separate codes. Venous catheterization is coded differently.
What Is Selective Arterial Catheterization?
Nonselective placement leaves the catheter in the aorta. Selective placement means purposefully entering a named branch artery, and the final catheter position matters. Advancing through a vessel to get somewhere else is not the same as selecting it. Code selection follows anatomy, as listed in CPT Appendix L, and the documented tip position.
Understanding the First, Second, and Third-Order Hierarchy
CPT 36245
• Represents: selective placement in a first-order branch of a vascular family.
• Documentation should establish: the named artery, family, and that this was the highest order reached.
• Coding consideration: Educational example: if the catheter stops in a branch Appendix L lists as first order for its family, evaluate 36245.
• Common mistake: adding 36245 when a deeper branch in the same family was reached.
CPT 36246
• Represents: initial second-order placement in a family.
• Documentation should establish: the second-order artery and final tip position.
• Coding consideration: The first-order branch passed through is included, not reported separately.
• Common mistake: reporting 36245 and 36246 for the same pathway.
CPT 36247
• Represents: initial third-order or more selective placement.
• Documentation should establish: the distal artery, pathway, and final tip location.
• Coding consideration: One initial code per family, and it replaces the lower-order codes.
• Common mistake: reporting 36247 twice in one family instead of using 36248 for the additional branch.
CPT +36248
• Represents: an add-on for each additional second-order, third-order, or higher branch within the same family, listed with 36246 or 36247.
• Documentation should establish: that each additional branch was separately and selectively catheterized.
• Coding consideration: It is not for additional first-order vessels per AAPC guidance.
• Common mistake: using it because another artery was seen on imaging from an existing position.
Understanding Vascular Families
A vascular family groups an artery with its branches, and Appendix L lists the first, second, third, and higher-order branches for each. You cannot determine order by counting vessels passed. You identify the family, then the deepest documented branch. The rule is to report the highest order reached in each family, with 36248 for further selected branches in that same family.
Interactive Vessel Selection Comparison
Coding situation | General coding consideration |
Catheter remains in the aorta | Nonselective placement principles apply |
Catheter selects a first-order branch | Evaluate 36245 |
Catheter advances into a second-order branch | Evaluate 36246 |
Catheter reaches a third-order or higher branch | Evaluate 36247 |
An additional qualifying branch is selectively catheterized | Evaluate +36248 when applicable |
These are simplified illustrations. Actual selection depends on documented anatomy, the vascular family, catheter positions, and CPT rules.
Common Coding and Billing Errors
Common error | Why it creates a problem | Better billing practice |
Reporting every vessel traversed | Pathway vessels are included in the higher-order selection | Report supported final selective positions |
Incorrect order assignment | Hierarchy may be misunderstood | Verify the vascular family |
Misusing 36248 | Not every additional vessel or image qualifies | Confirm additional selective placement |
Missing final catheter position | Insufficient support for the code | Review the complete report |
Confusing selective and nonselective placement | Wrong code assignment | Distinguish the final position |
Ignoring add-on rules | Incorrect claim reporting | Review CPT instructions |
Reporting bundled services separately | Coding and compliance issues | Check current NCCI edits |
Real-World Coding Scenarios
Educational examples, not definitive coding determinations.
Scenario | Documentation and consideration | Common error and principle |
1. First-order selection | Report documents a named first-order branch as the final position in its family. Evaluate 36245. | Error: adding a nonselective aortic code. Principle: selective placement replaces it. |
2. Third-order selection | Catheter passes first- and second-order vessels to a third-order branch. Evaluate 36247. | Error: also reporting 36245 and 36246. Principle: pathway vessels are included. |
3. Additional placement | A second branch of second order or higher in the same family is selectively entered and documented. Consider +36248. | Error: using 36248 for a vessel only visualized by imaging. Principle: separate selective work must be documented. |
NCCI Edits, Bundling, and Compliance Considerations
Medicare’s NCCI Policy Manual, Chapter 5 says that with vascular embolization codes 37241–37244, selective catheterization may be reported separately but non-selective catheterization may not. Lower-order placements along the same pathway are included in the highest order, and add-on codes are reported only with their primary code. No modifier makes a bundled service payable on its own. Check current NCCI edits and payer policies, since the linked chapter is the 2025 edition.
How Accurate Documentation Supports Better Reimbursement
Accurate procedure reports lead to consistent coding, cleaner claims, fewer avoidable denials, and better audit readiness. That helps revenue cycle performance, but it does not guarantee payment or any percentage improvement.
Sirius Solutions Global: Medical Billing and RCM Support for Complex Procedures
Sirius Solutions Global offers medical coding support, claims management, eligibility verification, denial management, A/R follow-up, medical billing audits, revenue leakage assessment, prior authorization, and credentialing and re-credentialing, using technology-assisted workflows with human verification. Coding review and documentation workflows can support interventional radiology and vascular billing. We do not claim IR-specific certifications, client outcomes, or success statistics. If catheterization coding is a concern, request a billing and RCM review.
Coding Knowledge Quiz
Question | Your answer | Answer and explanation |
1. Does advancing through a first-order vessel justify separate reporting when the catheter reaches a third-order destination? | ☐ Yes ☐ No | No. Only the highest order in the family is reported. |
2. Is CPT 36248 an add-on code? | ☐ Yes ☐ No | Yes. It is listed with 36246 or 36247. |
3. Does visualizing an additional artery establish an additional selective placement? | ☐ Yes ☐ No | No. The artery must be separately and selectively catheterized and documented. |
Frequently Asked Questions
▸ What are CPT codes 36245–36248 used for?
Reporting selective arterial catheter placement in abdominal, pelvic, and lower-extremity branches.
▸ What is the difference between 36245 and 36246?
The highest order reached in the family: first versus second.
▸ What does CPT 36247 represent?
Initial third-order or higher selective placement.
▸ When is CPT 36248 reported?
For each additional second-order or higher branch selected within the same family.
▸ Is CPT 36248 an add-on code?
Yes. It cannot be reported alone.
▸ What is a vascular family?
An artery and its branches as grouped in CPT Appendix L.
▸ Are vessels traversed during advancement separately billable?
No. Pathway vessels are included in the highest order reached.
▸ What documentation supports billing?
Named vessels, family, pathway, final tip location, and selective work for any additional branch.
▸ What is selective versus nonselective catheterization?
Selective enters a branch artery on purpose. Nonselective stays in the aorta.
▸ How can practices reduce coding errors?
Review reports against Appendix L, audit 36248 use, and check NCCI edits.
Disclaimer: This article is educational, published by Sirius Solutions Global, and is not a substitute for current CPT guidance, payer policies, or individualized coding review. CPT® is a registered trademark of the American Medical Association, and descriptors are paraphrased. Sirius Solutions Global is not affiliated with CMS or the AMA. Nothing here guarantees coverage, reimbursement, or audit outcomes.
