# Carotid and Arch Angiogram



## karbaker (Feb 1, 2018)

Help  coding carotid and arch angiogram.  I think I should code 36221???? Appreciate any help at all .  Thanks KBaker

PROCEDURES PERFORMED:  Aortic arch angiogram and bilateral carotid angiogram.

INDICATION:   has known CAD.  She has bilateral carotid bruits and a recent bilateral ultrasound of the neck reveals significant lesions in both carotids.

PROCEDURE:  Informed consent was obtained from the patient.  Patient was brought down to the cardiac catheterization ward in fasting state.  The right groin is draped and prepped in sterile fashion.  Next 2% lidocaine is used for anesthesia.  A 6-French introducer sheath was placed into the right femoral artery.  Using 6-French pigtail, aortic arch angiogram is performed.  Then, we used a JB1 catheter to selectively engage both the right and the left common carotid arteries and we did a bilateral carotid angiogram.  At the end of the procedure, catheters, wires, and tubes were withdrawn.  Hemostasis obtained with applying manual pressure on pulling the sheath out. 

ANGIOGRAPHIC FINDINGS:
1.  The aortic arch appears normal.  The aortic arch gives rise to a normal-appearing right brachiocephalic trunk, left common carotid artery, and the left subclavian artery.
2.  The left common carotid artery is normal and divides into right internal carotid artery and right external carotid artery.
3.  The right internal carotid artery in the proximal segment has 80% stenosis.
4.  The left common carotid artery has some plaque lesions and the left common carotid arch divides into the left external carotid artery and left internal carotid artery.
5.  The left internal carotid artery also has 80% stenosis.

CONCLUSIONS:  Bilateral internal carotid artery stenosis.

RECOMMENDATIONS:  Patient will have vascular surgery consultation with Dr. Bui for carotid endarterectomy.


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## cgbar (Feb 4, 2018)

Look at CPT 36222. The key is the documented selective engagement of the bilateral common carotids. You should add 50 modifier for the Bilateral since this is a unilateral code. Pretty sure the CPT book has an example of this (or similar) in description prior to the codes. 

Glenn


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