Cardiology Coding Alert

Question: How should I report diagnostic right common carotid artery angiography and right internal carotid artery angioplasty at the same session?

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Answer: You’ll need to check the documentation for more details about catheter placement and what was imaged before making your final code choice.

For instance, the doctor should specify intracranial or extracranial for internal carotid services because this blood vessel is located both inside and outside the cranium.

Diagnostic codes to consider: For catheter placement in the common carotid with extracranial (cervical) carotid imaging, choose 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).

But for cath placement in the common carotid with intracranial (cerebral) imaging, look to 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). Code 36223 also covers extracranial imaging if that’s performed at the same encounter.

Intervention: CPT® guidelines for the diagnostic codes instruct you to report both the diagnostic service and the intervention: "Diagnostic angiography of the cervicocerebral vessels may be followed by an interventional procedure at the same session. Interventional procedures may be separately reportable using standard coding conventions."

Depending on the location of the angioplasty, codes 35475 (Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel) and 75962-26 (Transluminal balloon angioplasty, peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation; Professional Component) may be appropriate. Coverage for carotid angioplasty can be tricky, however. Medicare covers it concurrent with stenting in specified situations such as trials, post-approval studies, and high-risk patients (search 20.7 at www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx for the National Coverage Determination). But if the physician also performs stent placement, you may not report the angioplasty separately.

There are also codes specific to intracranial angioplasty that differ based on the problem being treated:

• Stenosis: 61630, Balloon angioplasty, intracranial (e.g., atherosclerotic stenosis), percutaneous
• Vasospasm: 61640, Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel.