# New 2013 cpt 36222 vs 36223



## Liza559 (Dec 5, 2012)

We have read the 2 descriptions of these 2 codes and trying to set up our CDM changes for next year. Can anyone really explain the 2 differences, they both sound and seem to be the same?
Thank you


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## dpeoples (Dec 5, 2012)

Liza559 said:


> We have read the 2 descriptions of these 2 codes and trying to set up our CDM changes for next year. Can anyone really explain the 2 differences, they both sound and seem to be the same?
> Thank you



Both codes represent selection of the innominate or common cartotid arteries only (first order).

36222 includes images and interpretation of the *external* carotid distribution.

36223 includes images and interpretation of the *internal* carotid distribution.

HTH


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## Liza559 (Dec 5, 2012)

That is what we originally thought until reading the descrip of 36227 which is for the external only.


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## dpeoples (Dec 5, 2012)

Liza559 said:


> That is what we originally thought until reading the descrip of 36227 which is for the external only.



This code includes selection (catheter placement into) the external carotid (second or third order) 

See my edit on previous post for more info.

HTH


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## donnajrichmond (Dec 5, 2012)

Liza559 said:


> We have read the 2 descriptions of these 2 codes and trying to set up our CDM changes for next year. Can anyone really explain the 2 differences, they both sound and seem to be the same?
> Thank you



36222 is coded when the catheter is in the common carotid or innominate artery, and imaging is done of extracranial carotids.  This could be the common carotid, non-selective external carotid, and proximal internal carotid arteries (cervical segment of the internal carotid).  If you also do an arch study, it is included in 36222 and not coded separately.  (previously you would have coded on the left 36215, 75676, and possibly 75650; on the right, 36215 (if innominate) or 36216 (common carotid) and 75676, 75650)

36222 is coded when the catheter is in the common carotid or innominate artery and imaging is done of the intracranial carotid circulation.  this would be the distal internal carotid and any cerebral imaging done from a common carotid selection.  (previously you would have coded the same cath codes as above, but 75665, with possibly 75676 and 75650.) 

Each of these codes is unilateral, so if bilateral imaging is done, you would code them twice.

36227 is selective external carotid add-on code.


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## tblmt1966 (Aug 1, 2013)

This was a discussion in class. 

Code 75660 was delete  in 2012 [2013 edition]  told to report 36227 

Code 75662 was delete also in 2012 [2013 edition} told to report 36227 and append modifier 50

The teacher and well as our confused. 36227 is add on code. You do not add a modifier to an add on code. 

Please help


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## donnajrichmond (Aug 1, 2013)

tblmt1966 said:


> This was a discussion in class.
> 
> Code 75660 was delete  in 2012 [2013 edition]  told to report 36227
> 
> ...



You can use modifiers with add-on codes - except modifier 51. 
All of the new carotid/vertebral angiogram codes, except the arch study, are unilateral.  In this case, if bilateral external carotids are selected (after a common or internal carotid selective angiogram), then you have to use a modifier to indicate that both sides were selected and imaged.


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## Jim Pawloski (Aug 6, 2013)

donnajrichmond said:


> You can use modifiers with add-on codes - except modifier 51.
> All of the new carotid/vertebral angiogram codes, except the arch study, are unilateral.  In this case, if bilateral external carotids are selected (after a common or internal carotid selective angiogram), then you have to use a modifier to indicate that both sides were selected and imaged.



Hi Donna,
Which is better method to code for the neuro cases.  Assuming bilateral study, to use the modifier RT/ LT or Modifier -50.  Or does it just depends on the third party payor?

Thanks,
Jim Pawloski, CIRCC


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