CPT® Code 36218

Add-On Code

Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

A selective catheter placement procedure involves the introduction of a catheter into the arterial system, specifically targeting the thoracic or brachiocephalic branches within a single vascular family. This procedure is typically initiated by accessing an extremity artery, with the femoral artery being the preferred site for catheter insertion, although access can also be achieved through an upper extremity artery. The process begins with a small incision made at the chosen insertion site, followed by the placement of an introducer sheath into the artery. A guidewire is then inserted through the sheath, allowing for the advancement of the catheter into the aorta. The physician skillfully navigates the guidewire through the femoral and iliac arteries and into the aorta, subsequently advancing the catheter over the guidewire into the first-order branch of the thoracic or brachiocephalic region. The procedure continues as the physician selectively advances the catheter through higher-order branches—second, third, and beyond—until the catheter reaches the highest-order branch that requires evaluation. Once the catheter is properly positioned, the guidewire is removed, and the physician may perform an injection of medication or radiopaque contrast media as necessary to facilitate imaging or treatment. It is important to note that CPT® Code 36218 is specifically used for the catheterization of each additional second-, third-, or higher-order branch within the same vascular family, following the initial catheterization of a second or third-order vessel, which is coded separately.