CPT Changes 2013 – Carotid Angiography

The RUC Relativity Assessment Workgroup continues their mission of abandoning the component coding concept and bundling certain services into single codes based on their 75 percent rule.  For code pairs that are billed together greater than 75 percent of the time, new CPT codes are created that bundle multiple procedures into one single code.  Consolidation is helpful and reduces confusion for coders, but be aware consolidation can sometimes result in lower Medicare reimbursement.

In 2013, there are new codes for cervicocerebral angiography.  You will no longer use the component coding system for these services.  Therefore, CPT codes 75660 – 75685 have been deactivated, and the catheter placement codes (36200, 36215 – 36218) are bundled into the newly created codes.

There are eight new codes for cervicocerebral angiography, six of which are primary codes and two that are add-on codes.  These codes are intended to describe non-selective and selective arterial catheter placement and diagnostic imaging of the aortic arch, subclavian, carotid, innominate and vertebral arteries.

It is important to note that these codes include the work of accessing the vessel, placing the catheter, contrast injection, fluoroscopy, radiological supervision and interpretation, and closure of the arteriotomy.  However, these codes do not include embolization, angioplasty, or stent placement, which can be billed separately.  In addition, you can bill separately for ultrasound guidance used in vascular access.

The CPT codes, descriptions, and 2013 RVU’s are provided below:

36221 Nonselective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or  intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed [Work: 4.17, NonFac PE: 29.02, MP: 0.83]

36222 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed [Work: 5.53, NonFac PE: 36.08, MP: 0.98]

36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed [Work: 6.00, NonFac PE: 39.36, MP: 1.06]

36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and cervicocerebral arch, when performed [Work: 6.50, NonFac PE: 42.84, MP: 1.10]

36225 Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation,includes angiography of the cervicocerebral arch, when performed [Work: 6.00, NonFac PE: 39.00, MP: 1.05]

36226 Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated
radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed [Work: 6.50, NonFac PE: 43.85, MP: 1.10]

36227 Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) [Work: 2.09, NonFac PE: 5.00, MP: 0.33]

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 radiological supervision and interpretation (eg, middle cerebral artery, posterior inferior cerebellar artery) (List separately in addition to code for primary procedure) [Work: 4.25, NonFac PE: 30.49, MP:
0.67]

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CPT codes and their descriptors are copyright 2012 by the American Medical Association.