Understanding Carotid Angiography Bundling Intricacies and Coding Hierarchies
A guide for Medical Billers and Medical Coders
Angiography codes often pose coding questions. The possible reasons behind this could be:
a) Proper hierarchy when reporting vascular codes as system branches.
b) Integrating imaging, catheterization, and services in interventional procedures.
Cerebral & Carotid Angiography is simple for new coders.
After wrestling with accurately reporting these codes, insights emerged. Effective pointers and road maps make coding hierarchies more understandable.
This article shares helpful pointers for easier coding of extensive procedures.
Carotid Angiography
Carotid arteries from Aortic Arch supply blood to head, neck, and arms. Cerebral angiography is a straightforward 30-60 min inpatient/outpatient procedure. Cerebral angiography studies cerebral/carotid arteries for stroke, embolism, aneurysm, etc.
In 2013, new codes reported nonselective/selective catheter placement and imaging. CPT codes 36221-36228 cover Non-Selective and Selective Catheterization for Cerebral angiogram.
To code these procedures, understand :
First: Carotid arterial system anatomy (aortic arch, carotid, vertebral arteries)
Second: Where was the catheter located, and was contrast injected?
Last: We need to understand what part of the Carotid system was actually imaged.
Let’s have a look at the codes.
Non-Selective Aortic Arch Angiography:
Non-selective aortic arch angiography is the most basic service.
36221: Aorta angiography with carotid/vertebral and/or intracranial vessels, including cervicocerebral arch.
A non-selective aortogram is included in all selective codes below.
Selective Carotid Artery Angiography:
All these codes are for selective unilateral carotid artery imaging. These services have a hierarchy based on catheter selection and imaging extent.
Only one of these three codes is applicable per side in the following order: 36224 > 36223 > 32222.
36221-36226 include catheterization, angiography, and radiological supervision and interpretation. No separate coding is needed for catheter placement or radiological services.
- Vessel access
- Catheter placement
- Contrast injections
- Fluoroscopic Guidance
- Radiological supervision and interpretation (S&I)
- Arterial closure by pressure or device
Read on for details to help you choose the right code.
Again, Focus on catheter placement and imaging location. Color-coded system for catheter placement, angiography, and bundled imaging hierarchy. We hope it will be easy to follow:
36222 Selective catheter placements: Unilateral Common Carotid/Innominate Artery Angiography incl. Extracranial Carotid & Cervicocerebral Arch.
36223 Selective catheter placements: Unilateral Common Carotid/Innominate Artery angiography incl. Intracranial Carotid, Extracranial Carotid & Cervicocerebral Arch
36224 Selective catheter placements: Unilateral Internal Carotid Artery Angiography incl. Intracranial Carotid, Extracranial Carotid & Cervicocerebral Arch.
Add-On Code for Angiography:
+36227 External Carotid Artery angiography, incl. External Carotid Circulation & RS&I.
- Use of CPT add-on code 36227 should be reported in conjunction with 36222, 36223, or 36224.
Selective Vertebral Artery Angiography:
Only one of these two codes is applicable per side in the following order: 36226 > 36225.
36225 Selective catheter placements: Unilateral Subclavian/Innominate Artery Angiography incl. Vertebral Circulation & Cervicocerebral Arch
36226 Selective catheter placements: Unilateral Vertebral Artery angiography incl. Vertebral Circulation & Cervicocerebral Arch.
- Use of CPT add-on code 36228 requires the use of either CPT code 36224 or 36226.
Add-On Code for Angiography:
+36228 Unilateral Intracranial Branch angiography, incl. selected vessel circulation & RS&I.
Here are some quick tips to wrap it all up!
- Choose the Most Comprehensive Service.
- These codes are hierarchical, meaning these codes are built on a set-up, which determines the lower numbered codes or lesser codes are valued into the higher numbered codes.
- Report only one code from 36222-36224 for each same-side carotid territory.
- Choose code that represents the most selective catheter placement and all of the angiography services performed.
- Bilateral procedures with different hierarchies use modifier -59 on the “lesser” code in this hierarchy. Only requirement here is proper documentation.
- Don’t forget 36221 is the only unilateral code. Rest of the codes have bilateral indication. So, append the LT (Left), RT (Right) or 50 (Bilateral) appropriated to the procedure performed. The bilateral modifier is only used for the exact same procedure/code performed bilaterally.
AltuMED PracticeFit enables Medical Billers with an inbuilt scrubber feature, reducing the chances of coding errors to 92%. Schedule a PracticeFit demo to know more:
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