# Cerebral angiography



## iamlou (Jul 23, 2013)

I am new at interventional radiology coding, and my mentor has had to take an unexpected leave, which leaves me to do it all on my own. Yikes!!!  Anyway, 
I have this case I am trying to code, and have not done one like this before, so I am asking for help. Here is the scenario:
Via the right transfemoral approach a 4 French catheter was advanced to the aortic arch
without incident.  Utilizing standard technique the right internal carotid
artery was selectively catheterized.  Multiplanar filming of the right
internal carotid circulation was performed. The right internal carotid was
injected with cross compression of the left internal carotid artery was
performed. Catheter was then advanced into the right vertebral artery
without incident. Flow in this area was somewhat diminished.  The 4 French
catheter was immediately withdrawn and placed in the subclavian artery.
Biplanar vertebral angiography was performed upon subclavian injection with
a blood pressure cuff about the right arm. The catheter was then advanced
to the left internal carotid artery.  Multiplanar intracranial filming
performed. The catheter was then advanced to the left subclavian artery.
The left vertebral was not selectively catheterized.  A lateral left
vertebral angiogram was performed with the blood pressure cuff about the
left arm.
How would you code this? The more I read it, the more confused I'm getting. Thank you for any and all the help you can give me!


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## Jim Pawloski (Jul 23, 2013)

iamlou said:


> I am new at interventional radiology coding, and my mentor has had to take an unexpected leave, which leaves me to do it all on my own. Yikes!!!  Anyway,
> I have this case I am trying to code, and have not done one like this before, so I am asking for help. Here is the scenario:
> Via the right transfemoral approach a 4 French catheter was advanced to the aortic arch
> without incident.  Utilizing standard technique the right internal carotid
> ...



You have:
36224-rt for the right internal carotid
36224-lt for the left internal carotid
36225-rt for the right vertebral artery
36225-lt for the left vertebral artery

HTH,
Jim Pawloski, CIRCC


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## sriniphysio1@gmail.com (Jul 31, 2013)

Hi

i have a doubt regarding the chart even the physician manipulate 

catheter in subclavian artert we need to code 36225 or not

thanks
srinivasan cpc


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## sriniphysio1@gmail.com (Jul 31, 2013)

Sorry

one more doubt we need to code 36226 for vertebral artery

thanks
srinivasan cpc


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## dpeoples (Jul 31, 2013)

I agree with Jim.
36224 for RICA injection and intepretation
36224 for LICA injection and interpretation
36225 for R Subclavian injection and (vertebral) interpretation
36225 for L Subclavian injection and (vertebral) interpretation

HTH


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## sriniphysio1@gmail.com (Jul 31, 2013)

HELO SIR

AM NEW TO IVR CODING AND AM IN TRAINING IN IVR IN MY COMPANY CAN U PLZ 

EXPLAIN WHY WE NEED TO BILL ONLY 36225 ALONE FOR RT AND LT SUCLAVIAN 

ARTERY AND WAT ABOUT VERTEBRAL ARTERY

Thanks
Srinivasan CPC


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## dpeoples (Aug 1, 2013)

sriniphysio1@gmail.com said:


> HELO SIR
> 
> AM NEW TO IVR CODING AND AM IN TRAINING IN IVR IN MY COMPANY CAN U PLZ
> 
> ...



Hi,

36225 includes angiography of the vertbebral arteries...

36226 requires selection of the vertebral arteries with subsequent injection of contrast (angiography) in the vertebral arteries. In this case the vertebral arteries were not injected with contrast (_per documentation_).

HTH


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## donnajrichmond (Aug 1, 2013)

iamlou said:


> Utilizing standard technique the right internal carotid
> artery was selectively catheterized.  Multiplanar filming of the right
> internal carotid circulation was performed. The right internal carotid was
> injected with cross compression of the left internal carotid artery was
> ...



I probably agree with Danny and Jim, but I would clarify with the physician before I coded anything.  He does say (underlined and in red above) that the catheter was advanced into the right vertebral artery and flow was diminished.  I would make sure that he did not do an angiogram in the right vertebral itself.


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## sriniphysio1@gmail.com (Aug 1, 2013)

hello sir

Thanks for your reply i will ask so many doubts can you please clarify for me if you have

time

Thanks
srinivasan CPC


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## dpeoples (Aug 2, 2013)

donnajrichmond said:


> I probably agree with Danny and Jim, but I would clarify with the physician before I coded anything.  He does say (underlined and in red above) that the catheter was advanced into the right vertebral artery and flow was diminished.  I would make sure that he did not do an angiogram in the right vertebral itself.





I did see that. In my opinion the dimished flow does imply an injection for localization, which showed the catheter to be too large for the rt vert. It was "quickly" withdrawn to a safer postion for the angiography.

Just my opinion of course and that is how I would code it. Coding can be very subjective, experience is as valuable as knowledge.

HTH


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## donnajrichmond (Aug 2, 2013)

dpeoples said:


> I did see that. In my opinion the dimished flow does imply an injection for localization, which showed the catheter to be too large for the rt vert. It was "quickly" withdrawn to a safer postion for the angiography.
> 
> Just my opinion of course and that is how I would code it. Coding can be very subjective, experience is as valuable as knowledge.
> 
> HTH



I agree that I would not code 36226 as documented.  But I think that it needs to go back to the dictating physician for clarification.


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