Question:

I am looking for the correct codes to assign when our provider documents that bilateral selective carotid artery angiogram and intracerebral artery angiogram were performed followed by selective left subclavian artery and left vertebral artery angiogram. Would the correct coding be CPT® 36223-50 and 36226-LT? Or would it be 36223-50 and 36225-LT?

Answer:

As indicated below, these codes are chosen according to where you placed the catheter and what was imaged.

  • Assign 36223 if the catheter is placed into the common carotid artery with imaging of the intracerebral (internal carotid) vessels (with or without common carotid imaging).
  • Assign 36224 if the catheter is placed into the internal carotid artery with imaging of the intracerebral (internal carotid) vessels (with or without common carotid imaging.
  • Assign 36225 if the catheter is placed into the subclavian artery with imaging of the vertebral artery.
  • Assign 36226 if catheter placed into the vertebral artery with imaging of the vertebral artery.

From the verbiage in your question above, we would recommend that you assign the following:

36223-50 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
36225-LT 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

The best documentation practice is to have the physician document selective artery catheterized “with” imaging of xxx verses “and.”


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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.