Cardiology Coding Alert

Question: When I would code for a bilateral carotid angiogram in 2012, I would use 36215-59, 36216, and 75680-26. Now in 2013 I am not sure if am supposed to use 36223 or 36222. The difference is "intracranial" and "extracranial."

Codify Member

Answer: Because you mention deleted cervical carotid angiography code 75680 (Angiography, carotid, cervical, bilateral, radiological supervision and interpretation), check your 2013 documentation against extracranial code 36222 (Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed).

Cervical carotid arteries may be referred to as extracranial, and cerebral carotid arteries may be called intracranial.

Tip: Carefully review the references to both intracranial and extracranial in 36223 (Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed).

If documentation shows intracranial carotid angiography alone or shows both intracranial and extracranial carotid angiography, 36223 applies. You should not additionally report 36222. Cervicocerebral arch angiography is also included in 36222 and 36223 when performed with the carotid angiography services.

Bilateral: Also be sure to use modifiers to indicate the bilateral nature of the service. CPT® says to use modifier 50 (Bilateral procedure) if the same procedure is performed on both sides, and use modifier 59 (Distinct procedural service) if the services on each side are different. Payers may have their own preference, such as LT (Left side) and RT (Right side).

Snag: The original 2013 Medicare Physician Fee Schedule (MPFS) gave unilateral codes 36222-+36228 a bilateral indicator of "0," which meant Medicare would not pay extra for a bilateral service. The April fee schedule update revises the bilateral indicators for these codes to "1," allowing 150 percent payment for bilateral services. The change is retroactive to Jan. 1, 2013, so be sure all of your 2013 bilateral claims have been paid correctly. Review the update in CMS Transmittal 2663, CR 8169 (www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2663CP.pdf).