Carotids - Not Bovine

jewlz0879

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These always give me fits when the catheter starts moving all over...when they selectively cannulate different vessels off the same branch; that's when I get lost.

Scenario 1: RFA cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then advanced into the left internal carotid artery and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then withdrawn and advanced to the right common carotid to selectively cannulate and angiography completed.

Codes:
LCCA: 36215
LICA: 36216
Left Vertebral: 36216, 59
RCCA: 36216, 59
75680
75665
75685

Do I need to change my LICA 36216 to 36218? That's where I get confused. Understanding WHEN to do that. I really want to get this! LOL.

Scenario 2: RFA cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then withdrawn and advanced to the right common carotid where it's selectively cannulated and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then moved down to selectively cannulate the left subclavian and angiography completed.

What if he then went all the way to the right and selectively cannulated the right subclavian as well with angiography?

Codes:
LCCA: 36215
RCCA: 36216
Left Vertebral: 36216, 59 (or would I change this?)
Left Subclavian: 36215,59

With
Right Subclavian, 36218,59?

Thank you in advance to anyone who can help me better understand this!
 

jmcpolin

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Midvale, UT
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#1
Left Internal 36216
Left Vert 36216-59
Right Common 36216-59
I have always had to appeal the second 36216-59 and you don't code the 36215 for the left common because you had to go through that vessel to get to the Left Internal.

#2
Left internal 36216
Right common 36216-59
Left Vert 36216-59
 
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