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Prahlad Posted Wed 26th of February, 2020 06:44:19 AM
PROCEDURE PERFORMED: 1. Successful PTA and stent placement to severe stenosis of the left ICA with an 8 x 30 Cordis Precise stent. 2. Ascending thoracic aortogram. 3. Selective angiogram of the left common carotid artery. 4. Intracerebral angiography. 5. Modified 22 for a complex intervention. .............. POSTPROCEDURE DIAGNOSES: Successful percutaneous transluminal angioplasty and stent placement to the left internal carotid artery using distal protection device. This is a 90% stenosis reduced to less than 10% stenosis.
SuperCoder Answered Thu 27th of February, 2020 05:29:54 AM

Hi Prahlad,

Thank you for your question,

For ICA procedure, the CPT depends on the portion of the internal carotid in which the physician placed the stent. The internal carotid has both extracranial (cervical) and intracranial portions.

For Cervical: Code 37215 (Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection) was created to report percutaneous stent placement in the cervical portion of the extracranial carotid artery. The code includes the term "cervical" rather than extracranial "to clarify the intended site at or near the carotid bifurcation in the neck.


For Intracranial: If the stent is placed in the intracranial internal carotid, then you should report 61635 (Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed).

Also, for the thoracic aortogram, CPT 36200 can be used. In this procedure, the provider inserts a catheter into a distal artery and then into the aorta. He uses a needle and inserts a guidewire into the needle. The provider performs the procedure for aortography or for measuring pressure inside aorta.

Selective angiogram of the left common carotid artery not usually paid when stent placement is performed on the carotid artery only.

For Intracerebral angiography, make sure in which artery procedure has been performed and select the code from the code series 36221-36228. Also, keep a note that, this intracerebral artery should not be internal carotid artery, because stent placement already performed.

However, you can use Modified 22 for a complex intervention.

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

  • Increased intensity
  • Additional time
  • Technical difficulty
  • Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

Hope this helps!

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