Radiology Coding Alert

Decide between modifiers 50 and 59 for opposite side services.

CPT® 2013 will introduce eight new codes for cervicocerebral angiography. Master these highlights from the guidelines to have clean claims from day one.

To learn more about the codes, see "36221 to +36228 Shake Up Carotid and Vertebral Angiography in the New Year" on cover page.

1. What If the Imaging is Bilateral?

Coding for services 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.

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 append a modifier to the lesser code if you want to report services performed on opposite sides of the body.

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 for the right side and 36223-59 (Distinct procedural service) for the left side.

Caution: Payers may have modifier preferences that differ from CPT® guidelines, so watch for payer-specific reporting rules. For instance, some payers may require the use of modifier RT (Right side) or modifier LT (Left side).

2. What Additional Services Can You Report?

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

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.

The physician should document the medical necessity for using the ultrasound guidance in the patient's particular case. CPT® guidelines for ultrasound guidance also "require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized."