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Internal Carotid Artery Angiogram with Angioplasty

Mary ann Posted Thu 30th of May, 2013 16:00:56 PM

Pt. had a diagnostic right common carotid artery angiogram and was followed by a balloon angioplasty of the right ICA. What codes would you assign for this procedure? Thanks

SuperCoder Answered Tue 04th of June, 2013 02:27:42 AM

For the angiography, you’ll need to confirm exact cath placement and what exactly was imaged based on the documentation. For instance, 36222 is cath placement in the common carotid with cervical (extracranial) carotid imaging. 36223 is cath placement in the common carotid with cerebral (intracranial) carotid imaging. Keep in mind that the physician needs to specify intracranial or extracranial for the ICA.

The guidelines for the diagnostic codes state, “Diagnostic angiography of the cervicocerebral vessels may be followed by an interventional procedure at the same session. Interventional procedures may be separately reportable using standard coding conventions.” So depending on extracranial or intracranial, you could look at 35475/75962 or 61630 (or 61640 for vasospasm). However, coverage for carotid PTA is tricky. Medicare covers it concurrent with stenting in specified situations like trials, post-approval studies, and high-risk patients (search 20.7 at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx to see the PTA NCD). But if you have stent placement, you won’t code PTA separately.

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