# Diagnostic Cerebral Angiogram



## Shay2025

Im new to the interventional radiology coding scene.  If anyone can shed some light on this case... I would gladly appreciate it  





The pt was placed on the angiography table in the usual supine position. The lt groin was prepped and draped in the usual terile fashion. After giving the pt 10 ccs of  1 % lido in the lt groin, access to the lt common femoral artery was obtained using a micropuncture system. After serial dilation, a 6 french short sheath was advanced over a guidewire and hooked to heparinized saline flush. Through the sheath, a 5 rnch JB1 diagnostic catheter was advanced and selectively placed in vessel detailed  below.

 The catheter was removed. The sheath was removed and adequate hemostasis was obtained by using starclose device. There were no immediate complications. 

 S&I
 the frontal angiogram of the left subclavian artery from left subclavian injection demonstrates normal vessels
 The frontal and lateral posterior fossa angiogram obtained from the left vertebral artery inj. demostrates normal posterior fossa circulation
The frontal and lateral left common carotid artery bifurcation angiogram obtained from the left common carotid artery inj. demonstrates normal carotid bifurcation.
the frontal and lateral full cerebral angiogram obtained from the left common carotid artery injection demonstrates persistent perfect coiling of the left pericarotid ring aneurysm. No evidence of other new intracranial aneurysm.
The frontal and lateral right common carotid artery bifurcation angiogram obtained from the right common carotid artery inj. demonstrates normal carotid bifurication.
The full cerebral angiogram obtained from right common carotid artery inj. demonstrates normal intracranial circulation.
The frontal angiogram of the right subclavian artery obtained from right subclavian artery inj. demonstrates normal vessels. the ostium of the right vertebral artery is normal.
The posterior fossa angiogram obtained from right vertebral artery inj. demostrates normal posterior fossa circulation.


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## donnajrichmond

Shay2025 said:


> Im new to the interventional radiology coding scene.  If anyone can shed some light on this case... I would gladly appreciate it
> 
> 
> 
> 
> 
> The pt was placed on the angiography table in the usual supine position. The lt groin was prepped and draped in the usual terile fashion. After giving the pt 10 ccs of  1 % lido in the lt groin, access to the lt common femoral artery was obtained using a micropuncture system. After serial dilation, a 6 french short sheath was advanced over a guidewire and hooked to heparinized saline flush. Through the sheath, a 5 rnch JB1 diagnostic catheter was advanced and selectively placed in vessel detailed  below.
> 
> The catheter was removed. The sheath was removed and adequate hemostasis was obtained by using starclose device. There were no immediate complications.
> 
> S&I
> the frontal angiogram of the left subclavian artery from left subclavian injection demonstrates normal vessels
> The frontal and lateral posterior fossa angiogram obtained from the left vertebral artery inj. demostrates normal posterior fossa circulation
> The frontal and lateral left common carotid artery bifurcation angiogram obtained from the left common carotid artery inj. demonstrates normal carotid bifurcation.
> the frontal and lateral full cerebral angiogram obtained from the left common carotid artery injection demonstrates persistent perfect coiling of the left pericarotid ring aneurysm. No evidence of other new intracranial aneurysm.
> The frontal and lateral right common carotid artery bifurcation angiogram obtained from the right common carotid artery inj. demonstrates normal carotid bifurication.
> The full cerebral angiogram obtained from right common carotid artery inj. demonstrates normal intracranial circulation.
> The frontal angiogram of the right subclavian artery obtained from right subclavian artery inj. demonstrates normal vessels. the ostium of the right vertebral artery is normal.
> The posterior fossa angiogram obtained from right vertebral artery inj. demostrates normal posterior fossa circulation.



36217 - right vertebral selection 
36218 - right common carotid selection 
36216-59 - left vertebral selection 
36215-59 - left common carotid selection 
75671- bilateral cerebral carotid angiogram S & I
75680 - bilateral cervical carotid angiogram S & I 
75685 x 2 - bilateral vertebral angiogram s & I  (code with -50 or RT and LT or units as payer requires).  

I would not code for the subclavians without more information.  They appear to be roadmapping to find the vertebrals, especially on the right side.

If you are coding for the physician and he did this service at the hospital, add modifier -26 to the 70000 codes, but NOT the 36000 codes.


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## dpeoples

donnajrichmond said:


> 36217 - right vertebral selection
> 36218 - right common carotid selection
> 36216-59 - left vertebral selection
> 36215-59 - left common carotid selection
> 75671- bilateral cerebral carotid angiogram S & I
> 75680 - bilateral cervical carotid angiogram S & I
> 75685 x 2 - bilateral vertebral angiogram s & I  (code with -50 or RT and LT or units as payer requires).
> 
> I would not code for the subclavians without more information.  They appear to be roadmapping to find the vertebrals, especially on the right side.
> 
> If you are coding for the physician and he did this service at the hospital, add modifier -26 to the 70000 codes, but NOT the 36000 codes.



I agree with donna's codes. That is a very good point about the subclavians.

HTH


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## Shay2025

Thanks everyone...
Like i mentioned ... I am new to interventional radiology coding. Im trying to wrap my head around it but its just not there yet.
 I consider CIRCC's to be super coders...

 Do you guys have any tips or coding references you can point me to on the internet that you may use to code from? 
 Any suggestions would be deeply appreciated.


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