# arch & Carotid arteriograms



## lward (Feb 9, 2013)

I have the following report I would like opinions on coding.  I seem to talk myself into confusion.  ok here goes

Withe the patient supine on the Cath Lab table, the skin overlying the right common femoral artery was prepped and draped in the usual manner and infiltrated with local anesthetic.  Ultrasound evaluation of potential access sites was performed.  After successfully identifying a patent vessel, a permanent recording was created for the patient record.  Using ultrasound guidance a 6F sheath was placed by using the modified Seldinger technique.  Catheters were selectively placed and contrast imaging obtained of the arch, the right and left common carotid arteries (cervical and cerebral views), vertebral arteries (cervical and cerebral views) and subclavian arteries.  All catheters and wires were removed.  The sheath was removed and an Angioseal deployed uneventfully.  

Please & Thanks


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## janseez (Feb 9, 2013)

lward said:


> I have the following report I would like opinions on coding.  I seem to talk myself into confusion.  ok here goes
> 
> Withe the patient supine on the Cath Lab table, the skin overlying the right common femoral artery was prepped and draped in the usual manner and infiltrated with local anesthetic.  Ultrasound evaluation of potential access sites was performed.  After successfully identifying a patent vessel, a permanent recording was created for the patient record.  Using ultrasound guidance a 6F sheath was placed by using the modified Seldinger technique.  Catheters were selectively placed and contrast imaging obtained of the arch, the right and left common carotid arteries (cervical and cerebral views), vertebral arteries (cervical and cerebral views) and subclavian arteries.  All catheters and wires were removed.  The sheath was removed and an Angioseal deployed uneventfully.
> 
> Please & Thanks


Hi.

Here are the codes for the catheter placements with diagnostic imaging.  Is this the whole report? In order to report these codes there must be diagnostic evaluations of the vessels in which the catheters were placed.

US guidance = 76937
 the arch imaging in included in the more selective codes, so this is not coded separately. 
right and left common carotids = 36223 -50 (includes cervical and cerebral views)
right and left vertebral = 36226 -50 (includes cervical and cerebral views)
the subclavian arteries are included in 36226 per the coding hierarchy

Hope this helps!

Thank you.

Jeanette S  CPC, CIRCC, PCS


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## EikaMTGQueen (Feb 10, 2013)

I have a question about 36223. Isnt the difference from 36222 & 36223 

36222 - (extracranial) dont they have to catherize the cerebrals/carotids and only dictate that

36223 - (intracranials) dont they have to catherize the cerebrals/carotids but have to dicate those and in the intenal/maybe the externals

Off of this dictated report wouldnt you coded 36222 - 50 because its extracranial?

Thanks

Erica Ross CIRCC, RCC


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## janseez (Feb 11, 2013)

EikaMTGQueen said:


> I have a question about 36223. Isnt the difference from 36222 & 36223
> 
> 36222 - (extracranial) dont they have to catherize the cerebrals/carotids and only dictate that
> 
> ...





The report states cervical and cerebral views therefore this can be coded with 36223. The catheter is placed in the common carotids for these views.  

The cerebral views are the key for coding 36223 when the catheter is placed in the common carotid.

For more info please refer to CPT Changes for 2013.

Hope this helps.

Thanks,

Jeanette Seesholtz, CPC, CIRCC


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## EikaMTGQueen (Feb 11, 2013)

That still doesnt make sense by the charts that are highlighted. 

If a interventionalist catherizes the common/cerebrals and does angiography on them you can only code 36222-50

If a interventionlist catherizes the common/cerebrals and does angiography plus dictates the internal and possibly the externals that considered intracranial which is code 36223-50

Thanks
Erica Ross CIRCC, RCC


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## Jim Pawloski (Feb 12, 2013)

EikaMTGQueen said:


> That still doesnt make sense by the charts that are highlighted.
> 
> If a interventionalist catherizes the common/cerebrals and does angiography on them you can only code 36222-50
> 
> ...



If the common carotid carotid is selected and imaged, I bill 36222.
If the common carotid carotid is selected, and the carotid bifurcation and cerebral are imaged, I bill 36223.
If the Internal carotid is selected, and the cerebral vessels are imaged, then I would bill 36224.
If the external carotid is selected, then I would bill 36227.
HTH,
Jim Pawloski, CIRCC


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## cbing (Feb 18, 2013)

In regard to the bilateral head & neck angios, CMS made a mistake in the 2013 Physician Fee Schedule.  They listed these new codes with a bilateral status indicator of "0", which means the payment adjustment for bilateral services does not apply.  Until they get this fixed, hopefully within the next few month, 36222-36228 will be denied when billed as bilateral.  In the interum, it has been recommended that we code these as two line items with a -59 modifier on the second item (ie, 36224, 36224-59).  Aside from that, I agree with Jeanette's coding on the condition, as she stated, that there is more dictation in the full report of diagnostic findings at all levels.

Erica, it sounds like you may have misunderstood these new codes, or I am misunderstanding you.  Are you aware that "cerebral" and "intracranial" are synonomous when coding these angios?  So, if they mention the cerebral arteries, that qualifies as intracranial.  Also, the internal carotids can be either intracranial or extracranial, depending on which portion is being imaged.  Therefore, just because they mention the ICA's, this does not necessarily mean it was intracranial.  Also, when you mentioned the "externals" below, are you referring to the external carotid arteries, or extracranial arteries?  The external carotid arteries have nothing to do with codes 36222-36224 and are coded with 36227 when selectively injected and imaged diagnostically.

I hope this helps.

Corinna Bing, CPC, RCC, CIRCC


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