Ask Dr. Z

Can we bill separately for the carotid cutdown/exposure (37799) to selectively catheterize the carotid artery when attempts to access the cerebral artery failed via percutaneous approach? Would this be 61645-22 instead or nothing at all?

"Instead, the left neck was prepped and cutdown in a sterile fashion employing a longitudinal incision to expose the carotid bifurcation.divided and dissection was carried down the medial border of the sternocleidomastoid. The internal jugular vein and vagus nerves were identified. The carotid complex, including the carotid bifurcation was exposed. Circumferential dissection was carried out around the common carotid artery. A vessel loop was placed around the CCA for proximal control. A U-stitch was made around the entry point of the catheter using a 6-0 Prolene. The vessel was accessed with a 5 Fr micropuncture kit and a 6 Fr Prelude 4 cm sheath under fluoroscopic guidance and secured appropriately. Craniocervical digital biplane angiography of the left internal carotid artery was then performed."