# External Carotid Catherization



## drobinson1 (Jun 6, 2013)

What is the CPT code for an external carotid catherization? I checked 36222-36228 aand I know i would use the add on code 36227 but which do I use first? Here is the report:

After obtaining informed consent, using Xylocaine local anesthesia and aseptic technique the right common femoral artery was punctured with a 19-gauge needle and a 0.035 inch Bentson guidewire advanced into the abdominal aorta. A 5-French sheath was placed and a 5-French H1 H. catheter used to select both right and left external carotid arteries. Left external carotid arteriography demonstrated a mild to moderate area of hyperemia in the region of the left nasal septum and maxillary sinus without neovascularity. This was fed by minute branches which were not amenable to catheterization.

Right external carotid artery catheterization demonstrated no focal contrast extravasation or pseudoaneurysm. There was minimal distal vascularity in the region of the internal maxillary artery. Lingual artery and internal maxillary catheterization with coaxial 3-French microcatheter did not demonstrate pseudoaneurysm or tumor vascularity. No embolization was performed. The findings were discussed with Dr. Newman. If the patient should have severe rebleeding repeat arteriography by interventional neuroradiologist may be helpful.

The catheter and sheath were removed. Hemostasis was accomplished by manual compression. 100 mL of nonionic contrast was used. Fluoroscopic and digital subtraction images on file, fluoroscopy time 14.6 minutes.

Impression:
No suitable vessels for embolization on the right; minute branches supplying moderate vascularity on the left, see above.


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## hwilcox07 (Jul 3, 2013)

36222 & 36227 and modifier 50 or RT and LT modifiers depending on payer.


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## sashka (Jul 10, 2013)

*36227*

From this dictation I'd code 36217, 36216-59. 36227 is not reported w/o a base code; there are no findings supporting other angiography codes.
Also, somebody asked a similar question on ZHealthPublishing website; here is Dr.Z's answer:  Question ID: 4661,  Answer:
"Per guidance in the CPT Code Book, a carotid angio (36222, 36223, or 36224) must be done to submit code 36227.  You may want to discuss with your physicians concerning this requirement."  -Dr. Z


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