CPT® Code 36254

Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral

A superselective catheter placement involves the precise positioning of a catheter into one or more second order or higher branches of the renal arteries for the purpose of conducting renal angiography. This procedure is initiated by accessing an artery, typically the femoral artery located in the groin, through a small incision. An introducer sheath is inserted into the artery, followed by the placement of a guidewire that facilitates the advancement of the catheter. Under fluoroscopic guidance, the guidewire is navigated through the femoral and iliac arteries into the aorta, allowing the catheter to be advanced into the main renal artery. The physician then selectively maneuvers the catheter into higher order branches of the renal arteries, which may include second, third, or even higher order branches, depending on the specific areas that require evaluation. Once the catheter is positioned appropriately, the guidewire is removed, and radiopaque contrast media may be injected to enhance imaging. This procedure may also include pressure gradient measurements to assess any narrowing in the renal arteries that could impact blood flow to the kidneys. The entire process is documented through image acquisition, post-processing, and permanent recording, culminating in a comprehensive review and written report by the physician detailing the findings of the angiography. It is important to note that for a unilateral super-selective renal angiogram, the code 36253 should be used, while 36254 is designated for a bilateral study.