Radiology Coding Alert

Question: Which code should I use when our radiologist advances a catheter deep into the cerebral vasculature during angiography?

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Answer: This is no easy question to answer, since there are a number of vessels within the head and neck.

The head contains vessels that extend from the main branches deep into the brain, which may not specifically be described by an existing CPT angiography imaging code.

If multiple catheterizations are performed in the same vascular family, use surgical code +36218 (Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family [List in addition to code for initial second or third order vessel as appropriate]) for each super-selective catheterization that is performed after the initial second or third order catheterization in that vascular family.

If a single third-order or beyond catheterization is performed in each vascular family, report 36217 (Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family)only once for that vascular family. That code includes all lesser-order catheterizations within that specific vascular family required to reach the final catheter placement.

You might also use +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [List separately in addition to code for primary procedure]) if an all-inclusive diagnostic study is performed during the same setting. For example, if a unilateral cerebral angiogram or a bilateral cerebral angiogram was performed during the same session, a study of a more selective portion of the cerebral vasculature would be described by 75774.

For example, an interventional radiologist may initially perform angiography of the internal carotid, which would be coded 75665 (Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation). However, to make sure the study pinpointed the entire area of a particular pathology (e.g., arterio-venous malformation, tumor), the catheter may be advanced further into the distant branches, such as the middle cerebral artery, and additional imaging performed. In this situation it would be appropriate to assign 75774 to describe this additional selective angiography.

Coders should note that these "each additional" angiography RS&I codes are assigned only once for each selective angiogram performed to supplement the basic examination. For example, 75774 is not assigned for multiple injections or views of the same vessel, since 75774 describes the RS&I for each additional vessel studied beyond the basic examination.