correct codes

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could someone please review this cerebral angio report and tell me how you would code this case. the md and i are in disagreement on some of the codes. thanks.

frustrated in Asheville!!!
 

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coffee2day

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I came up with -

36224-50 for rt/lt internal carotid artery cath
36226-50 for rt/lt vertebral artery cath
did not code for left subclavian cath as this is bundled with the further catherization of the left vertebral artery ipsilateral side
76377-26 3d imaging



Free Dr. Z Article has one example of not coding the subclavian cath when vertebral artery cath was done on same side -
https://www.aapc.com/blog/22548-get-busy-learning-new-cervico-cerebral-imaging-re-imagined/

"Both 36225 and 36226 include imaging of the neck and head. These codes are unilateral, and follow similar guidelines as the carotid arteries for bilateral procedures. Selective vertebral codes include imaging of the arch (if done), and have a hierarchy of 36226 > 36225."

"Example 2: The patient is 57-years-old with possible vertebro-basilar insufficiency. Via a right common femoral puncture, a catheter is advanced into the arch and cervico-cerebral arch angiography is performed (36221). A catheter is advanced into the right subclavian artery and vertebral artery imaging is performed (delete 36221, add 36225). This injection fails to show retrograde flow down the left vertebral. The catheter is then placed into the left subclavian and advanced further into the left vertebral artery, and selective left vertebral artery imaging is performed (add 36226, append modifier 59 to 36225, above). The left vertebral ends in the posterior inferior cerebellar artery (PICA)."

CIRCC
 
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