Need help with Cervical cerebral angio

Hunteru

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PREOPERATIVE DIAGNOSIS: Prior carotid endarterectomy with restenosis of
the right internal carotid artery
POSTOPERATIVE DIAGNOSIS: Nonobstructive narrowing of both internal
carotid arteries
PROCEDURE PERFORMED:
1. Arch aortography
2. Selective angiography of bilateral common carotid arteries with
cervical and cerebral imaging
INDICATIONS FOR PROCEDURE: The patient has a remote history of bilateral
carotid endarterectomy. Surveillance Doppler ultrasound had shown
steadily increasing velocities in the right internal carotid artery which
finally reached a level of significance. She was therefore referred for
angiographic evaluation.
COUNSELING: The procedure, as well as its risks, benefits, and
alternatives, were discussed in detail with the patient. The patient was
agreeable. Therefore, the appropriate consents were signed and placed on
the chart.
PROCEDURE IN DETAIL: The patient was brought to the catheterization
laboratory in a fasting state with in IV line in place. A pre-procedure
"Time-Out" was performed by the Physician, Cardiology Nurse,
Cardiovascular Scrub Technologist and Cardio-Vascular Technologist
confirming patient identification and procedure location. Bilateral
groins were prepped and draped in the usual sterile fashion. The right
groin was anesthetized with 1% lidocaine. Using a modified Seldinger
technique the right femoral artery was accessed and a 5 French sheath was
inserted. 3000 units of heparin were given via the sheath. A 5 French
pigtail catheter is advanced into the aortic arch. Arch aortography was
performed. The catheter was then exchanged for a 5 French Headhunter
catheter which was used to selectively engage and performed angiography
of both carotid arteries. At the conclusion of the procedure, all wires
and catheters were removed. Hemostasis was obtained with manual pressure.
There was no hematoma or bleeding at the conclusion of the procedure.
The patient tolerated the procedure well. There were no complications.
Total fluoroscopic time was 5.4.
Total contrast volume was 90 mL of Visipaque.
Findings:
1. Aortic arch: The aortic arch is calcified. It is a type III arch. The
ostia of all the brachiocephalic vessels are widely patent.
2. Right carotid system: The right common carotid artery is widely
patent and shows a normal bifurcation into its internal and external
branches. The right internal carotid artery is narrowed in the bulb
approximately 50% in severity. Intracranial portion of the internal
carotid artery has plaquing which does not significant narrow the lumen.
Intracerebral imaging shows no evidence of AV malformation, aneurysm or
significant atherosclerosis.
3. Left carotid system: The left common carotid artery is widely patent
and shows a normal bifurcation into its internal and external branches.
The left internal carotid artery is narrowed in the bulb less than 50% in
severity. The intracranial portion of the internal carotid artery has
plaquing which does not significantly narrow the lumen. Intracerebral
imaging shows no evidence of AV malformation, aneurysm, or significant
atherosclerotic narrowing.
4. Right vertebral artery: The right vertebral artery was not selectively
imaged but is patent.
5. Left vertebral artery: The left vertebral artery was not selectively
imaged but is patent.
IMPRESSION: 1. Less than 50% narrowing of bilateral internal carotid
arteries.


Physician wants 36221, 36222,36223 submitted for services rendered. Would this all fall under 36222??? Per note only the carotid is selected and the arch is included in the code.
Any help with this would be greatly appreciated....
 

amandamkcj

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I only see 36223-50. CPT 36223 is when the catheter is located in the common carotid or innominate artery and imaging is performed of the intracranial carotid circulation. The report supports this service. CPT 36221 and 36222 bundle into 36223 and maynot be separately reported and since report indicates bilateral common carotid arteries were cath and imaging of common and internal is why I added 50 mod to 36223.
Hope this is helpful,
Amanda RCC, CPC, CIRCC
 
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