Big Changes in 2013 for Carotid and Vertebral Angiography CPT Codes

One of the biggest coding changes radiology practices will see in 2013 is a new series of codes specific to cervicocerebral angiography.

Effective January 1, 2013, the AMA’s CPT will delete angiography and radiological supervision and interpretation (RS&I) codes 75650, 75660, 75662, 75665, 75671, 75676, 75680, and 75685 for the carotid, cerebral, vertebral, and cervical arteries because the work in these codes is included, or bundled, in a new series of codes developed for reporting carotid angiography services. 

The new series of codes, 36221-36226, will include vessel access, catheter placement, any contrast injections, fluoroscopy, RS&I, and arterial closure by pressure or device. 

• 36221 Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated RS&I, includes angiography of the cervicocerebral arch, when performed
o This CPT code only applies when the catheter goes as far as the thoracic aorta and no farther.
o Also note that 36221 specifies “unilateral or bilateral.”  All of the other CPT codes in this series are designated as unilateral.
• 36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated RS&I, includes angiography of the cervicocerebral arch, when performed
• 36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated RS&I, includes angiography of the extracranial carotid and cervicocerebral arch, when performed
• 36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated RS&I, includes angiography of the extracranial carotid and cervicocerebral arch, when performed
o Guidelines instruct that these codes (36222-36224) are hierarchical and can only be reported once for each same side carotid territory.  For example, if the physician places the catheter in the left common carotid and images the extracranial circulation and then places the catheter in the left internal carotid and images the intracranial circulation, report only 36224. Code 36224 represents the most selective catheter placement and all of the angiography services performed.

The next two codes are also hierarchical, only varying based on catheter placement and should only be reported once per same side vertebral territory:

• 36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associate RS&I, includes angiography of the cervicocerebral arch, when performed
• 36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated RS&I, includes angiography of the cervicocerebral arch, when performed

There are also two new add-on codes, to be reported in addition to the primary procedure as specified below:

• +36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated RS&I (List separately in addition to code for primary procedure)
o CPT guidelines state that this code includes artery access, catheter placement, contrast injection, fluoroscopy, and RS&I. 
o 36227 should be reported in conjunction with 36222, 36223, or 36224
• +36228 Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated RS&I (ie, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure)
o Guidelines clarify that 36228 should not be reported more than twice per side regardless of number of additional branches selectively catheterized.
o A single unit of the code includes artery access, catheter placement, contrast injection, fluoroscopy, and RS&I.  It also includes any additional second or third order catheter placement performed in that branch.
o  36228 should be reported in conjunction with 36224 and 36226