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selective cath placement for cerebral angio

  1. #1
    Default selective cath placement for cerebral angio
    Medical Coding Books
    Hi all--

    Can you please comment to help me confirm the appropriate 36000 series for this given cerebral angiogram scenario?

    Patient is normal arch arterial anatomy.
    RFA approach.

    If you selectively engage...

    Left Vertebral
    Left Common Carotid
    Left Internal Carotid
    Left External Carotid

    You catheter placements are:
    36216 -- left vertebral
    36216 -- left internal carotid
    36218 -- left external carotid

  2. #2
    Default
    Quote Originally Posted by jtuominen View Post
    Hi all--

    Can you please comment to help me confirm the appropriate 36000 series for this given cerebral angiogram scenario?

    Patient is normal arch arterial anatomy.
    RFA approach.

    If you selectively engage...

    Left Vertebral
    Left Common Carotid
    Left Internal Carotid
    Left External Carotid

    You catheter placements are:
    36216 -- left vertebral
    36216 -- left internal carotid
    36218 -- left external carotid
    You got it!!!
    Thanks,
    Jim Pawloski, CIRCC

  3. Default
    Your cath placements are correct. Good Job!

  4. #4
    Default
    Thanks for the help, now Ive just got one more really tricky one that I don't understand

    Normal arch, RFA approach

    R ICA
    L ICA
    Posterior Comm from Right
    Posterior Comm from Left
    Right Middle Cerebral
    Left Middle Cerebral

    I get cath placements of:
    36217 - R ICA
    36218 - Post Comm from Right
    36218 - R Middle Cerebral

    36217 - Left Middle Cerebral
    36218 - Post Comm from Left

    But when I looked this up in a book I got from a consultant they coded
    On the Right:
    36217
    36218

    On the Left:
    36217
    36218

    Why not the extra 36218 on the right?
    Help!

  5. #5
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by jtuominen View Post
    Thanks for the help, now Ive just got one more really tricky one that I don't understand

    Normal arch, RFA approach

    R ICA
    L ICA
    Posterior Comm from Right
    Posterior Comm from Left
    Right Middle Cerebral
    Left Middle Cerebral

    I get cath placements of:
    36217 - R ICA
    36218 - Post Comm from Right
    36218 - R Middle Cerebral

    36217 - Left Middle Cerebral
    36218 - Post Comm from Left

    But when I looked this up in a book I got from a consultant they coded
    On the Right:
    36217 this is for the Right Posterior Communicating Artery
    36218 this is for the Right Middle Cerebral Artery

    On the Left:
    36217 LT PCA
    36218 LT MCA
    Why not the extra 36218 on the right?
    Help!

    Selecting the RPCA or RMCA requires navigation through the RICA, so it is part of the pathway and is not separately coded. This is actually the same as on the left and I noticed you did not code the LICA. Did I miss something?

    HTH
    Danny L. Peoples
    CIRCC,CPC

  6. #6
    Smile
    I think i get this, so since we went through the R ICA to get to the posterior commmunicating, we code to the highest order of selectivity which is the posterior communicating. Even though the RICA is 36217 and the posterior is 36217 as well. So I end up with the two catheter placements of 36217 for the posterior communicating on the right and 36218 for my cath placement to the right middle cerebral?

    I guess I must be getting hung up on the fact that I think the RICA is my highest level of selectivitiy as far as the CPT codes go (36217) and therefore I need to make sure it is coded. But we "went through it, so I lose it" in order to get to the posterior communicating, right?

    Thanks for the help! These vessels way up in the brain are my weak spot that I want to make sure I figure out

  7. Default
    Not only am I a coder but was an IVR Tech for 20 yrs, GREAT JOB

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