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Monica Posted Thu 23rd of May, 2013 20:53:05 PM

CPT's I have for this are: 36222-50 and 36225 BUT
a co-worker indicated it should be 36222-50, 36215. If it is 36215 rather than 36225, WHY???? Thank you!!!

PROCEDURE PERFORMED: Right subclavian angiogram, left subclavian angiogram, right selective carotid angiogram, left selective carotid angiogram, femoral angiogram.

Percutaneous entry into the right common femoral artery was done without difficulty percutaneously. Through a 6 sheath was passed 0.035 wire, a pigtail catheter and an aortic arch angiogram was first performed. The arch aortogram was performed that showed calcification involving the aorta. In adition, there was diffuse ectatic disease involving the right common carotid artery. The left common carotid artery and had a moderate stenosis estimated to be 30% to 50% smooth and non-ulcerated. Selective study was then performed at the right subclavian artery. This vessel showed mild disease involving the right subclavian takeoff and flow through the right carotid artery as well as right vertebral artery appeared unimpeded. There was evidence of ectatic disease involving the proximal right common carotid artery as noted. A selective study of the right common carotid artery was then perormed and the bifurcation was clearly looked at, involving the common carotid artery. There was evidence of disease involving the bifurcation with an estimated stenosis of 30% to 40%. There was mild-ulceration seen involving the internal carotid as well at its origin.

Selective study was then done of the left carotid system. The left common carotid artery had its origin narrowed as noted above. In addition, at the bifucation, there were multiple areas of ulceration identified in the distal common, internal and origin of he internal carotid artery.

Selective study of the subclavian artery showed this vessel to have the stent without significant instent restenosis. Stent stoped before the origin of left vertebral artery an d flow was then impeded throughout the subclavian as well as left vertebral system.

Femoral angiogram was then perofrmed. A mynx closure device was inserted.

SuperCoder Answered Tue 28th of May, 2013 14:03:22 PM

36222-50, 36225-50 appear correct. CPT guidelines state, “Only one code in the range 36222-36224 may be reported for each ipsilateral carotid territory. Only one code in the range 36225-36226 may be reported for each ipsilateral vertebral territory.” So the two areas have separate hierarchies. These presentation slides include examples that may help:

Monica Posted Tue 28th of May, 2013 18:04:31 PM

This was incredibly helpful. Thank you!

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