# Carotid Angiogram



## amym (Jun 5, 2014)

I am lost with this one... please help me code.  

Charges were turned in for thoracic aortogram, selective LT and RT common carotid angiogram, bilateral non selective internal and external carotid angiogram, non-selective cerebral bilateral angiogram.  

Through the right common femoral artery using modified seldinger method, the 5-french pigtail was placed in the aorta and a root shot was performed which revealed a bovine type 2 arch.
After that, a 5-french jr4 diagnostic catheter was used to cannulate the right common carotid artery, and the catheter ____ was parked in the right common carotid artery and angiographic shots were obtained, which showed 20% lesion in the right internal carotid artery and the proximal aorta.  After that, the catheter was withdrawn and the catheter was placed in the left common carotid artery, and further angiogram was performed though that.  This angiography revealed 90% ulcerated left common carotid artery.  After that procedure was stopped. 475834


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## Jim Pawloski (Jun 8, 2014)

amym said:


> I am lost with this one... please help me code.
> 
> Charges were turned in for thoracic aortogram, selective LT and RT common carotid angiogram, bilateral non selective internal and external carotid angiogram, non-selective cerebral bilateral angiogram.
> 
> ...



36222-50 is what you have.  I don't see anything about the cerebral vasculature to code 36223-50.

Thanks,
Jim Pawloski, CIRCC


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## TWinsor (Jun 9, 2014)

Hi Jim,

I am a little confused.  Don't code these much but I see in the note "20% lesion in Rt ICA" wouldn't this account for the cerebral at least on the right?

Thank you in advance.


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## Jim Pawloski (Jun 9, 2014)

TWinsor said:


> Hi Jim,
> 
> I am a little confused.  Don't code these much but I see in the note "20% lesion in Rt ICA" wouldn't this account for the cerebral at least on the right?
> 
> Thank you in advance.



That stenosis could be at the carotid bifurcation.  There are no comments of the anterior or middle cerebral arteries to count for "cerebral" arteriogram.

Thanks,
Jim Pawloski, CIRCC


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## theresa.dix@tennova.com (Jun 13, 2014)

Jim Pawloski said:


> That stenosis could be at the carotid bifurcation.  There are no comments of the anterior or middle cerebral arteries to count for "cerebral" arteriogram.
> 
> Thanks,
> Jim Pawloski, CIRCC



Jim,
 I am confused too about this I have tried to study the new codes but dont do enough of these anymore. Could this be coded like this

36223(right) cath placement and because of the 20% lesion in the internal carotid considered intracranial (cerebral)imaging?

36222-59(left) left common cath placement with imaging?

or am I interpreting this wrong? I have some handouts from AMA guiding me.


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## dpeoples (Jun 13, 2014)

The 20% lesion in the RICA could be intracranial, or not. The real question is would this be a good defense in an audit for 36223. My philosophy is if you are going to be wrong (with a code), be conservative. I would also stick with 36222-50.

HTH


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