# Diagnostic cerebral angiogram -question



## endrest (Apr 19, 2013)

Trying to wrap my head around 36221-36224. What codes would you use for this case? (I'm looking at 36223)

NAME OF OPERATION/PROCEDURE:
1. Diagnostic arch angiogram.
2. Selective cannulation of the innominate.
3. Angiogram of the right carotid artery.
4. Right cerebral angiogram.

DESCRIPTION OF PROCEDURE:
At this time, there was then use of ultrasound for micropuncture
technique in the right groin.  We went up into the arch.  We did diagnostic
arch angiogram.  We used multiple catheters to select the innominate artery,
which had a stent at the origin.  We used a JB2,  as well as
angled glide and headhunter.  We were able to cannulate with a JB2.  At this
time, we did a diagnostic angiogram of the carotid as well as the cerebrum.
At this time, we then exchanged out for an Amplatz wire and attempted to put
the sheath up.  The sheath was then able to pass through the innominate
stent.  At this time, there were then attempts to continue to pass the sheath
although it did not appear to pass.  Based on this, it was decided we then
would end this procedure and likely approach the right carotid from the right
arm.  This was based on the anatomy now with the stent in the position.  At
this time, the patient was given 3000 units of heparin at the time of
manipulation of the arch.  At this time, all sheaths and wires were removed
and pressure was held at the right groin.  

Thank you forum!


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## Jim Pawloski (Apr 21, 2013)

endrest said:


> Trying to wrap my head around 36221-36224. What codes would you use for this case? (I'm looking at 36223)
> 
> NAME OF OPERATION/PROCEDURE:
> 1. Diagnostic arch angiogram.
> ...


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