Wiki New to Interventional Radiology coding, need help!

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tiakitty16

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I'm new to this, and am having a very difficult time trying to assign the correct codes to Cerebral Angiograms. Can anyone help?

Here is the procedure:

Right vertebral artery: Intracranial view
Under fluoroscopic guidance the catheter was advanced into the origin
of the right vertebral artery and biplane angiography was performed
over the cranium. Intracranial views of the right vertebral artery in
the AP and lateral projections demonstrate a normal distal V3, and V4
segments of the right vertebral artery. The right vertebral artery
ends in a large PICA/AICA complex with minimal contribution to the
basilar artery. This is a normal anatomic variant. There is no reflux
of contrast into the contralateral intradural segment of the left
vertebral artery. *There is no significant stenosis or dissection.
There is no aneurysm or arteriovenous malformation.
*
Right common carotid artery: Intracranial view *
Under fluoroscopic guidance the catheter was advanced into the right
common carotid artery, and biplane angiography was performed over the
cranium. The intracranial view of the right common carotid artery in
the AP and lateral projections demonstrates absence of contribution of
flow into the distal ICA via the right common carotid artery. The
distal ICA is reconstituted beyond the cavernous segment via opthalmic
collaterals from the external carotid artery. There is some reflux of
flow into the ipsilateral vertebral artery. There is a normal right
external carotid artery and its branches including the internal
maxillary artery and superficial temporal artery. There is no aneurysm
or arteriovenous malformation. *
*
Right common carotid artery: Cervical view
Under fluoroscopic guidance, with the catheter in the right common
carotid artery, biplane angiography was performed of the cervical
region. The cervical view of the right common carotid artery in the AP
and lateral projections demonstrates a complete occlusion of the right
internal carotid artery at its origin. There is a normal right
external carotid artery and its branches. There is no significant
stenosis. There is no aneurysm or arteriovenous malformation.
*
Left common carotid artery: Intracranial view
Under fluoroscopic guidance, the catheter was advanced into the left
common carotid artery, and biplane angiography was performed over the
cranium. Intracranial view of the left common carotid artery in the AP
and lateral projections demonstrates robust cross-flow to the
contralateral right ACA and right MCA vs the anterior communicating
artery. There is visualization of a normal left ICA, normal bilateral
MCAs, and normal bilateral ACAs. The left P-comm is not visualized.
The intracranial branches of the left external carotid artery are well
visualized and are normal. There is no significant stenosis or
dissection. There is no aneurysm or AVM noted.
*
Left vertebral artery: Intracranial view
Under fluoroscopic guidance the catheter was advanced into the left
vertebral artery, and biplane angiography was performed over the
cranium. Intracranial views of the left vertebral artery in the AP and
lateral projections demonstrates a normal distal V3, and V4 segments
of the left vertebral artery. There is a normal basilar artery. The
left PCA is well visualized. There is some flow to the left ACA
through an intact left P-comm. Bilateral SCAs are well visualized and
are normal. Bilateral AICAs are well visualized and are normal. The
*

*
*
*
*
left PICA is well visualized and arises from the intradural V4 segment
of the left vertebral artery and is normal. There is no significant
stenosis or dissection. There is no aneurysm or arteriovenous
malformation.
*
Right Common femoral artery: Pelvic view
Under fluoroscopic guidance the catheter was withdrawn into the right
common femoral artery. Angiography was performed over the right common
femoral artery. Pelvic view of the right common femoral artery in the
right anterior oblique projection demonstrates a normal right common
femoral artery, a normal right superficial femoral artery and a normal
right deep femoral artery. The point of entry of the sheath is just
above the femoral bifurcation. There is no significant stenosis or
dissection. There is no aneurysm or AV fistula.



I'm at a complete loss, if anyone is willing to highlight and code this out so i can start understanding how to do it, I would greatly appreciate it!
 
tiakitty16 said:
I'm new to this, and am having a very difficult time trying to assign the correct codes to Cerebral Angiograms. Can anyone help?

Here is the procedure:

Right vertebral artery: Intracranial view 36226-RT
Under fluoroscopic guidance the catheter was advanced into the origin
of the right vertebral artery and biplane angiography was performed
over the cranium. Intracranial views of the right vertebral artery in
the AP and lateral projections demonstrate a normal distal V3, and V4
segments of the right vertebral artery. The right vertebral artery
ends in a large PICA/AICA complex with minimal contribution to the
basilar artery. This is a normal anatomic variant. There is no reflux
of contrast into the contralateral intradural segment of the left
vertebral artery. *There is no significant stenosis or dissection.
There is no aneurysm or arteriovenous malformation.
*
Right common carotid artery: Intracranial view *
Under fluoroscopic guidance the catheter was advanced into the right
common carotid artery, and biplane angiography was performed over the
cranium. The intracranial view of the right common carotid artery in
the AP and lateral projections demonstrates absence of contribution of
flow into the distal ICA via the right common carotid artery. The
distal ICA is reconstituted beyond the cavernous segment via opthalmic
collaterals from the external carotid artery. There is some reflux of
flow into the ipsilateral vertebral artery. There is a normal right
external carotid artery and its branches including the internal
maxillary artery and superficial temporal artery. There is no aneurysm
or arteriovenous malformation. *
*
Right common carotid artery: Cervical view
Under fluoroscopic guidance, with the catheter in the right common
carotid artery, biplane angiography was performed of the cervical
region. The cervical view of the right common carotid artery in the AP
and lateral projections demonstrates a complete occlusion of the right
internal carotid artery at its origin. There is a normal right
external carotid artery and its branches. There is no significant
stenosis. There is no aneurysm or arteriovenous malformation.
*
Left common carotid artery: Intracranial view
Under fluoroscopic guidance, the catheter was advanced into the left
common carotid artery, and biplane angiography was performed over the
cranium. Intracranial view of the left common carotid artery in the AP
and lateral projections demonstrates robust cross-flow to the
contralateral right ACA and right MCA vs the anterior communicating
artery. There is visualization of a normal left ICA, normal bilateral
MCAs, and normal bilateral ACAs. The left P-comm is not visualized.
The intracranial branches of the left external carotid artery are well
visualized and are normal. There is no significant stenosis or
dissection. There is no aneurysm or AVM noted.
*
Left vertebral artery: Intracranial view
Under fluoroscopic guidance the catheter was advanced into the left
vertebral artery, and biplane angiography was performed over the
cranium. Intracranial views of the left vertebral artery in the AP and
lateral projections demonstrates a normal distal V3, and V4 segments
of the left vertebral artery. There is a normal basilar artery. The
left PCA is well visualized. There is some flow to the left ACA
through an intact left P-comm. Bilateral SCAs are well visualized and
are normal. Bilateral AICAs are well visualized and are normal. The
*

*
*
*
*
left PICA is well visualized and arises from the intradural V4 segment
of the left vertebral artery and is normal. There is no significant
stenosis or dissection. There is no aneurysm or arteriovenous
malformation.
*
Right Common femoral artery: Pelvic view
Under fluoroscopic guidance the catheter was withdrawn into the right
common femoral artery. Angiography was performed over the right common
femoral artery. Pelvic view of the right common femoral artery in the
right anterior oblique projection demonstrates a normal right common
femoral artery, a normal right superficial femoral artery and a normal
right deep femoral artery. The point of entry of the sheath is just
above the femoral bifurcation. There is no significant stenosis or
dissection. There is no aneurysm or AV fistula.



I'm at a complete loss, if anyone is willing to highlight and code this out so i can start understanding how to do it, I would greatly appreciate it!
Click to expand...

First, see where the catheter went. Then see what was imaged. In this case the catheter went into the vertebral artery on both sides, and then the catheter went into the common carotid artery bilaterally, and for imaging, you have bilateral vertebral, bilateral carotid neck and cerebral arteries imaged. So for codes, 36223-50 for the carotids and 36226 for the vertebrals.
HTH,
Jim Pawloski, CIRCC
 
tiakitty16 said:
So I don't code for the femoral artery correct? What about the vertebral arteries?
Click to expand...

First, the femoral artery is your access site. Also, the cervicocerebral codes have the catheter selectivity is bundled in the code. Second, 36226 is the selective vertebral artery.

Thanks,
Jim
 
Jim Pawloski said:
First, the femoral artery is your access site. Also, the cervicocerebral codes have the catheter selectivity is bundled in the code. Second, 36226 is the selective vertebral artery.

Thanks,
Jim
Click to expand...

I am trying to bill out an angiography, and it keeps saying non-covered DX, not covered under Medicare part B, I'm using 99233-25 and 36223-LT with I67.1 DX for a different angiogram than we discussed. I can't use a different Icd-10 code because that is the DX the physician uses. What am i doing wrong?
 
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