# selective cath placement for cerebral angio



## jtuominen (Jun 16, 2010)

Hi all--

Can you please comment to help me confirm the appropriate 36000 series for this given cerebral angiogram scenario?

Patient is normal arch arterial anatomy.
RFA approach.

If you selectively engage...

Left Vertebral
Left Common Carotid
Left Internal Carotid
Left External Carotid

You catheter placements are:
36216 -- left vertebral
36216 -- left internal carotid
36218 -- left external carotid


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## Jim Pawloski (Jun 16, 2010)

jtuominen said:


> Hi all--
> 
> Can you please comment to help me confirm the appropriate 36000 series for this given cerebral angiogram scenario?
> 
> ...



You got it!!!
Thanks,
Jim Pawloski, CIRCC


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## boogiebowden (Jun 17, 2010)

Your cath placements are correct.  Good Job!


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## jtuominen (Jun 17, 2010)

Thanks for the help, now Ive just got one more really tricky one that I don't understand

Normal arch, RFA approach

R ICA
L ICA
Posterior Comm from Right
Posterior Comm from Left
Right Middle Cerebral
Left Middle Cerebral

I get cath placements of:
36217 - R ICA
36218 - Post Comm from Right
36218 - R Middle Cerebral

36217 - Left Middle Cerebral
36218 - Post Comm from Left

But when I looked this up in a book I got from a consultant they coded
On the Right:
36217
36218

On the Left:
36217
36218

Why not the extra 36218 on the right?
Help!


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## dpeoples (Jun 17, 2010)

jtuominen said:


> Thanks for the help, now Ive just got one more really tricky one that I don't understand
> 
> Normal arch, RFA approach
> 
> ...




Selecting the RPCA or RMCA requires navigation through the RICA, so it is part of the pathway and is not separately coded. This is actually the same as on the left and I noticed you did not code the LICA. Did I miss something?

HTH


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## jtuominen (Jun 17, 2010)

I think i get this, so since we went through the R ICA to get to the posterior commmunicating, we code to the highest order of selectivity which is the posterior communicating. Even though the RICA is 36217 and the posterior is 36217 as well. So I end up with the two catheter placements of 36217 for the posterior communicating on the right and 36218 for my cath placement to the right middle cerebral?

I guess I must be getting hung up on the fact that I think the RICA is my highest level of selectivitiy as far as the CPT codes go (36217) and therefore I need to make sure it is coded. But we "went through it, so I lose it" in order to get to the posterior communicating, right?

Thanks for the help! These vessels way up in the brain are my weak spot that I want to make sure I figure out


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## kbazarte@yahoo.com (Jun 22, 2010)

Not only am I a coder but was an IVR Tech for 20 yrs, GREAT JOB


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