Ask Dr. Z

Can you report code 36224 with this procedure since no actual embolectomy was done? Patient first had a CTA of head that showed left M1 MCA occlusion, then was taken to IR lab. Report reads as," Right CFA access with catheter into left CCA. Angiogram done of cerebral vessels. There was difficulty advancing wires due to tortuous vessels. Wire was advanced into left ICA, and a Neuron Max sheath was advanced over wire into left CCA. With a different catheter we eventually got into the left cavernous ICA and angiogram done. I was unable to advance embolectomy catheter, and then the sheath prolapsed into the aorta. No further attempts were made. ProGlide device for closure." Findings of the left carotid and cerebral vessels are described, and report states, "No embolectomy was performed." Since patient has KNOWN MCA occlusion from CTA and embolectomy not done, I am not sure what to code here. Can we report code 36224 even with CTA being done before angio? Or do you code 61645-74, or just cath placement 36217 (pt has Bovine arch)?