# 36224 vs 36225 and 36226



## jhcpc09

Can you someone clarify?  In the guidelines it states 36221-36226 are built on heirarchy and only one code can be used.  Then it goes onto say 36225-36226 may be reported for each ipsilateral vertebral territory.  So let's say cath is placed in internal carotid (36224) imaging and findings aer provided of common carotid, and internal carotid.  Then cath is pulled back and placed in the vertebral.  would it then be appropriate to charge for both 36224 and 36226 -59 because the cath is repositioned into the vertebral?


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## donnajrichmond

jhcpc09 said:


> Can you someone clarify?  In the guidelines it states 36221-36226 are built on heirarchy and only one code can be used.  Then it goes onto say 36225-36226 may be reported for each ipsilateral vertebral territory.  So let's say cath is placed in internal carotid (36224) imaging and findings aer provided of common carotid, and internal carotid.  Then cath is pulled back and placed in the vertebral.  would it then be appropriate to charge for both 36224 and 36226 -59 because the cath is repositioned into the vertebral?



Actually the guidelines do not say tht only one code from 36221-36226 can be coded.  It says 36221-36226 are built on progressive hierarchies... Only one code in the range 36222-36224 may be reported for each ipsilateral carotid territory.  Only one code in the range 36225-36226 may be reported for each ipsilateral vertebral territory".  Hiercharies (plural), not hierchary (singular) - one heirchary for the carotids, one for the vertebral.

So, yes, if both the internal carotid and the vertebral are selected and imaged you would code 36224 and 36226.  Modifier -59 should not be needed.  If bilateral internal carotids and bilateral vertebrals are selected and imaged you would code 36224-50 and 36226-50.


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## dpeoples

donnajrichmond said:


> Actually the guidelines do not say tht only one code from 36221-36226 can be coded.  It says 36221-36226 are built on progressive hierarchies... Only one code in the range 36222-36224 may be reported for each ipsilateral carotid territory.  Only one code in the range 36225-36226 may be reported for each ipsilateral vertebral territory".  Hiercharies (plural), not hierchary (singular) - one heirchary for the carotids, one for the vertebral.
> 
> So, yes, if both the internal carotid and the vertebral are selected and imaged you would code 36224 and 36226.  Modifier -59 should not be needed.  If bilateral internal carotids and bilateral vertebrals are selected and imaged you would code 36224-50 and 36226-50.



Great explanation!


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## rebeccadyke84

Regarding the 50 modifier - I use the STS Coding website as my source for CCI edits and it is telling me not to use 50 with 36222-36228. But it is telling me I can use RT and LT. However, when I tried to bill these none of them would work. (the 50, RT or LT). 
But all of the webinars and articles I've read about these new codes said to use 50. I'm confused!


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## donnajrichmond

rebeccadyke84 said:


> Regarding the 50 modifier - I use the STS Coding website as my source for CCI edits and it is telling me not to use 50 with 36222-36228. But it is telling me I can use RT and LT. However, when I tried to bill these none of them would work. (the 50, RT or LT).
> But all of the webinars and articles I've read about these new codes said to use 50. I'm confused!



Correct coding and payer coding do not always agree.  Modifier use is a really good example of this.  You have to know how an individual payer wants multiples coded. 
When CMS came out with the RVU file for 2013 (after the original question), they made most of these codes with a bilateral indicator of "0" - which means you can't use modifier 50 or LT /RT.  You would have to use -59.  My understanding is that they may change that for 2Q, but for right now, for Medicare, you use -59.  
Other payers - you can start with -59 if you don't have guidance from them (if you are contracted, check the payer website for information.)


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