CPT Coding Guidelines Review: Cervicocerebral Arteries Diagnostic Studies

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for diagnostic angiography of the cervicocerebral arteries.

CPT Guidelines Diagnostic Angiography of the Cervicocerebral Arteries

Please watch this presentation to learn about the guidelines that provide direction in assigning CPT codes for diagnostic angiography of the cervicocerebral arteries.

Take Aways

• The work reported with codes 36221-36226 includes:
  • Accessing the vessel
  • Placement of catheters
  • Contrast injections
  • Fluoroscopy
  • Radiological supervision and interpretation
  • Closure of the arteriotomy
• Interventional procedures performed during the same session as diagnostic angiography of the cervicocerebral arteries is separately reportable
• Coding for diagnostic angiography of the cervicocerebral arteries is based on progressive hierarchies. Report only the code for the most comprehensive service in the hierarchy
• Assign modifier -50 when the same procedure is performed on both sides of the body during the same session
• Assign modifier -59 when different territories are studied on both sides of the body during the same session.
• Certain imaging procedures such as ultrasound guidance to gain vascular access are separately reportable

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

To find additional instruction in coding for interventional radiology procedures, explore the course Interventional Radiology CPT Coding Introduction on HIAlearn.com. .

Additional Coding Education: Invest in You!

Be sure to watch for other installments of CPT Coding Guidelines Review and visit HIAlearn.com to explore other educational products designed to help coders be their best! Subscribe to our YouTube channel to be notified when the next video is live.

Quiz Answers and Rationale

Question 1: The answer is angioplasty. An angioplasty is an interventional procedure that may be reported separately when performed with diagnostic angiography during the same session. Fluoroscopy, accessing the vessel and injecting contrast are all included in the work of diagnostic angiography of the cervicocerebral arteries.

Question 2: The answer is 36222-50. 36222 reports Selective catheterization of each common carotid artery with bilateral extracranial carotid angiography. A -50 modifier is needed to indicate this same procedure was performed bilaterally.

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.