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Carotids and vertebrals

Date: Mar 14, 2013

Question:

Hello Dr. Z! I have a question regarding code 36226: In scenario A the patient was brought in for an angio due to SAH. The physician catheterized the left ascending cervical artery, the findings read: "Left vertebral artery origin is occluded. The ascending cervical artery reconstitutes the distal left vertebral artery which supplies the PICA. No aneurysm is seen. No AVM." 36225 doesn't capture the catheterization but 36226 states it should be the vertebral artery. What is appropriate to code? In scenario B the patient was also brought in for an angio due to SAH. However, the physician bilaterally catheterized the subclavian, costocervical & thyrocervical arteries to rule out cervicalmedullary AVM. Findings for all arteries read: "No evidence of AV shunting." (The vertebrals, ICA's & ECA's were all imaged as well.) Would the evaluation of the subclavians, costocervicals & thyrocervicals be seen as inherent within codes 36224, 36226 and 36227? Can code 36228 be used to capture this additional work? Thanks for the help Dr. Z, it's much appreciated!
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