Cardiology Coding Alert

Question: The patient was brought to the cardiac Cath Lab in a fasting and non-sedated state. Informed consent was signed and obtained. By using a modified center technique and ultrasound guidance, the physician was able to successfully puncture the right common femoral artery and place a micro-puncture sheath upsized to a 6 French sheath. This was followed by a pigtail catheter at the level of the ascending aorta to allow for angiography. The physician then exchanged this for a VTK catheter, which cannulated the right brachiocephalic artery, the left subclavian artery, and the left common carotid artery to allow for selective angiography and intracerebral angiography. During these procedures, findings included a type I aortic arch; left internal carotid artery stenosis, 80 percent with significant concentric calcification; patent left subclavian artery; dominant right vertebral artery; patent right internal carotid artery; and intracerebral crossover right to left flow. What procedure codes should I report on my claim?

North Carolina Subscriber

Answer: Report code 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) with modifier 50 (Bilateral procedure) appended for the carotids and 36225 (Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed) with modifier 50 appended for the vertebrals.

Don’t miss: Never report 36223 in conjunction with the transcatheter placement of intravascular stent codes 37215, 37216, or 37218 for the treated carotid artery, per CPT^®.