Cardiology Coding Alert

Plus: Discover which services are reportable in addition to the new cervicocerebral angiography codes.

For clean claims, veteran coders know coding guidelines can be just as important as code definitions. This quick Q&A based on CPT^® 2013 guidelines will flesh out your 36221-+36228 coding know-how.

1. What If the Imaging is Bilateral?

Coding for cervicocerebral services performed on both sides of the neck/head will depend on whether the same territory or different territories are imaged on both sides.

Modifier 50: If the physician performs the same procedure on both sides, then you should append modifier 50 (Bilateral procedure) to the appropriate code, CPT^® guidelines instruct.

For instance, if the physician positions the catheter in the right vertebral artery and images the right vertebral circulation, and then maneuvers the catheter over to the left vertebral artery and performs imaging there, you should append modifier 50 to 36226 (Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed).

Modifier 59: In some cases, the physician may perform different services on each side. Because coding rules may prevent reporting the two codes together for services performed on the same side of the body, you may need to use a modifier if you want to report services performed on opposite sides of the body. Append the modifier to the lesser code, stated Sean P. Roddy, MD, FACS, of the Society for Vascular Surgery and AMA CPT^® Advisory Committee, in the Vascular Surgery and Interventional Radiology presentation at the CPT^® and RBRVS 2013 Annual Symposium.

As an example, suppose the physician performs left intracranial carotid imaging from the left common carotid and then performs right intracranial imaging from the right internal carotid. You should report 36224 (Selective catheter placement, internal carotid artery, unilateral, 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) for the right side and 36223-59 (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) for the left side.

Caution: Payers may have modifier preferences that differ from CPT^® guidelines, so watch for payer-specific reporting rules.

2. What Additional Services Can You Report?

Interventions: Codes 36221-+36228 describe diagnostic angiography. Just as with other true diagnostic angiography services, you may separately report interventions performed at the same session as the diagnostic angiography, when warranted.

Distinct diagnostic services: CPT^® guidelines instruct you not to report +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [List separately in addition to code for primary procedure]) "as part of diagnostic angiography of the extracranial and intracranial cervicocerebral vessels." But if the physician performs angiography in other areas during the same session, you may report those separately, including +75774 if appropriate.

3D: When performed, you may report the codes for 3D rendering in conjunction with 36221-+36228. Note that the descriptors for the 3D codes will change for 2013 to add the underlined text:

76376, 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation

76377, … requiring image postprocessing on an independent workstation.

US guidance: You may report +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure]) in conjunction with 36221-+36228 when documentation meets the code requirements. But it is not appropriate to code +76937 when the physician uses US guidance simply to mark a vessel for access. The physician must document performing the requirements in the code definition to capture this service.

Also see: To learn more about the codes, see "36221 Leads the Long List of New Carotid and Vertebral Angiography Codes" in Cardiology Coding Alert, vol. 16, no. 1.