Carotid stent placement & diagnostic carotid angio

endrest

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Can you bill for diagnostic arch angiogram and diagnostic angio of carotid during the same operative session upon placing a Carotid Stent (37215) what codes would you use?
Description of procedure is below.
THANK YOU!

NAME OF OPERATION/PROCEDURE:
1. Diagnostic arch angiogram.
2. Selective cannulation of the innominate artery and the right common
carotid artery.
3. Diagnostic angio of the carotid, as well as the cerebral right hemisphere.
4. Balloon angioplasty and stent of the right internal carotid artery using a
10 x 40-mm stent, there is pre dilatation with a 4 x 2 balloon followed by a
5 x 4 balloon post stent deployment angioplasty.

used an ultrasound for micropuncture
technique in the right groin. We then went up with a JB 2 catheter and
selective the innominate artery. Diagnostic angiograms were performed
showing the right common carotid artery with a severe stenosis of 85% distal
to the patch. We then placed a Magic Torque wire into the external carotid
artery. The patient was heparinized with 2000 units of heparin. A working
shuttle sheath was placed into the common carotid artery, this was then
followed by 4000 units of heparin. ACT was performed and found to be greater
than 250. At this time there was then use of a Cordis embolic protection
device which was able to cross the lesion. This was a 6-mm device and was
deployed without difficulty. Following this, based on the severity of the
stenosis, there was a preballoon dilatation with a 4 x 2 balloon. After
predilatation, there was then placement of the stent. The stent was a 10 x
10 in diameter x 40-mm stent. This was deployed and flared into the proximal
portion of the common carotid artery. Status post this there was then
balloon angioplasty with a 5 x 4 balloon. Status post balloon angioplasty
and stent, there was now minimal residual stenosis. Diagnostic cerebral
angiogram preprocedure and postprocedure showed no evidence of significant
malformation, no change preprocedure and postprocedure, as well as no
evidence of significant AV malformation.
 

Jmate

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Assuming this is indeed the initial diagnostic arch angio and no prior diagnostic angio was done prior to this intervention I'd code 36222 with 37215.
 

endrest

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3-6 months ago evaluation with CTA showed severe stenosis, does that qualify for pryor diagnostic?

Also, what clued you into to use 36222 (extracranial) vs 36223 (intracranial) these two confuse me?

:)
 

Jim Pawloski

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3-6 months ago evaluation with CTA showed severe stenosis, does that qualify for pryor diagnostic?

Also, what clued you into to use 36222 (extracranial) vs 36223 (intracranial) these two confuse me?

:)
For 36222 Catheter is in the common catotid and the carotid bifurcation is imaged, for 36223, the catheter is in the common carotid, and the intracrainal circulation is imaged.
HTH,
Jim Pawloski, CIRCC
 

dpeoples

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Can you bill for diagnostic arch angiogram and diagnostic angio of carotid during the same operative session upon placing a Carotid Stent (37215) what codes would you use?
Description of procedure is below.
THANK YOU!

NAME OF OPERATION/PROCEDURE:
1. Diagnostic arch angiogram.
2. Selective cannulation of the innominate artery and the right common
carotid artery.
3. Diagnostic angio of the carotid, as well as the cerebral right hemisphere.
4. Balloon angioplasty and stent of the right internal carotid artery using a
10 x 40-mm stent, there is pre dilatation with a 4 x 2 balloon followed by a
5 x 4 balloon post stent deployment angioplasty.

used an ultrasound for micropuncture
technique in the right groin. We then went up with a JB 2 catheter and
selective the innominate artery. Diagnostic angiograms were performed
showing the right common carotid artery with a severe stenosis of 85% distal
to the patch. We then placed a Magic Torque wire into the external carotid
artery. The patient was heparinized with 2000 units of heparin. A working
shuttle sheath was placed into the common carotid artery, this was then
followed by 4000 units of heparin. ACT was performed and found to be greater
than 250. At this time there was then use of a Cordis embolic protection
device which was able to cross the lesion. This was a 6-mm device and was
deployed without difficulty. Following this, based on the severity of the
stenosis, there was a preballoon dilatation with a 4 x 2 balloon. After
predilatation, there was then placement of the stent. The stent was a 10 x
10 in diameter x 40-mm stent. This was deployed and flared into the proximal
portion of the common carotid artery. Status post this there was then
balloon angioplasty with a 5 x 4 balloon. Status post balloon angioplasty
and stent, there was now minimal residual stenosis. Diagnostic cerebral
angiogram preprocedure and postprocedure showed no evidence of significant
malformation, no change preprocedure and postprocedure, as well as no
evidence of significant AV malformation.
Don't mean to confuse, you can (at least you could before the new codes) bill for the arch study, but not for the carotid study on the side being treated. If the opposide is imaged, you will need to add modifer 59 to that code.

37215 and 36221 are the codes I would code.



HTH :)
 
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I have a couple of questions...
1) why wouldn't 36223 be used, wasn't the innominate selected?
2) is the angioplasty not billable because the stent is more comprehensive?

I am new to interventional radiology and I love this forum, I try to figure out what I would bill and then compare it to the answers...it's great practice for me.

Does anyone know of any kind of workbook I could get that would help me practice coding...especially catheter placement.

Thanks,
Sue
 

endrest

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Thank You Danny! The diagnostic arch 36221makes sense to me now. Appreciate it!
 

Jim Pawloski

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I have a couple of questions...
1) why wouldn't 36223 be used, wasn't the innominate selected?
2) is the angioplasty not billable because the stent is more comprehensive?

I am new to interventional radiology and I love this forum, I try to figure out what I would bill and then compare it to the answers...it's great practice for me.

Does anyone know of any kind of workbook I could get that would help me practice coding...especially catheter placement.

Thanks,
Sue
To answer your questions, 36223 is part of the right carotid family, so it is bundled into the carotid stent, and bundled into any the the carotid codes on the right. For the second question, stent placement supersedes atherectomy which supersedes angioplasty.
HTH,
Jim Pawloski, CIRCC
 

amneske

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For 36222 Catheter is in the common catotid and the carotid bifurcation is imaged, for 36223, the catheter is in the common carotid, and the intracrainal circulation is imaged.
HTH,
Jim Pawloski, CIRCC
can someone give me their definition of the intracranial circulation? i was under the impression that if anything beyond the skull base was imaged that was intracranial. Between the aortic arch and skull base was extracranial?
 

Jim Pawloski

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can someone give me their definition of the intracranial circulation? i was under the impression that if anything beyond the skull base was imaged that was intracranial. Between the aortic arch and skull base was extracranial?
You got it! Common Carotids and bifurcations and the external carotids are extracrainal.
Thanks,
Jim Pawloski, CIRCC
 
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