Can anyone please help!!! I am literaly about to pull my hair out on these new codes. It says they are built on heiracrchy and 36222-36224 can only be billed one time but I'm not seeing the heirachy. This is my understading please breakdown to english for me.
36223 and 36224 are geting me. what's the difference?
36222 is common coratids
36223 is interal carotids
36224 External???? with 224 including 36222 and 36224??? 36227 would be added if both external carotids were engaged????
am I at least going tin the right direction??? Or is 23 external and 24 for the interals? I really need to undersand it this way not the formal terms.
I'm begging Please help!!!!![/QUOTE
To know which code/s to assign you have to know both where the catheter is and what was imaged.
36221 - catheter is in the thoracic aorta and does not go further. Any head and neck imaging done from this location is 36221. (36200, 75650)
36222 supercedes 36221. The catheter goes beyond the aorta into either the common carotid artery or the innominate artery. Imaging is of the extracranial carotids (common carotid, external carotid, proximal internal carotid). Imaging of the arch is included if performed. (on the right side this would have been 36215 (innominate) or 36216 (rt common carotid) with 75676 and 75650)
36223 supercedes 36222. The catheter is still in the common carotid or the innominate, but intracranial (cerebral) imaging is done (distal internal carotid and any cerebral branches). Extracranial carotid and arch imaging is included if performed. (rt. side 36215 or 36216, 75665, 75676, 75650)
36224 supercedes 36223. The internal carotid artery is catheterized, with intracranial (cerebral) imaging is performed. Included extracranial and arch imaging if performed. Imaging here is the same as 36223, but the catheter is higher up (more selective). (rt. side - 36217, 75665, 75676, 75650)
36227 is an add-on code to 36222, 36223, or 36224. It is used whenafter either innominate, common or internal carotid catheterization the external carotid (or it's branches) is also selected.
36228 is another add-on code for use when one or two cerebral branches of either the internal carotid or the vertebral artery are selected and imaged. This would be, for example, middle cerebral, anterior cerebral, etc. Code a maximum of 2 per side, regardless of how many branches are selected.
These codes, except for 36221, are all unilateral. If bilateral studies are done, code the appropriate code for each side.