Improve Your Angio Skills With This Carotid Scenario

Knowing right from left can get you a $105 reward.

How do you handle a medical billing and coding case with a common carotid placement through both common and internal carotid imaging?

Have a look at the following scenario: By means of femoral access and common carotid placement, the physician images the right common carotid as well as right internal carotid. The physician documents normal anatomy and maintains that there are no abnormalities in the common carotid, however she finds stenosis in the internal carotid.

Determine your answer, and then see if your solution to this medical billing and coding scenario is similar to the experts'.

Image 2 Vessels From Same Placement?

The scenario specifies catheter placement terminated in the common carotid, however the cardiologist imaged both the common and internal carotid arteries. Supposing your documentation supports it, you will be able to report imaging for both the common as well as internal carotid arteries.

This imaging of both vessels is possible as the contrast flows upward. Consequently, physicians can inject contrast at the common carotid artery and render the interpretation of not only the common carotid bifurcation, specifying what is seen ([for example,] the common carotid bifurcation was clean and free of disease), however also intracranial segments of the internal carotid artery.

The codes: For the unilateral common (cervical) carotid artery angiography, you must report CPT code 75676 (Angiography, carotid, cervical, unilateral, radiological supervision and interpretation). You should apply 75665 (Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation) for unilateral intracranial (cerebral) carotid artery angiography.

Keep in mind to verify that the physician's documentation for the scenario stated above supports reporting the cerebral code (based on what she performed and the recorded findings) along with the cervical code to attain medical billing and coding accuracy.

Rake in Rightful Correct Carotid Fee

Along with imaging, you need to select the proper catheter placement code. One significant factor is whether the cardiologist worked in the left or right carotid arteries. In the scenario mentioned above, the cardiologist placed the catheter in the patient's right common carotid.

Impact: The right common carotid originates from the innominate artery which branches from the aorta. Consequently, from a femoral approach, the innominate is the first-order catheterization, and the right common carotid is a second-order catheterization. Then again, the patient's left common carotid originates from the aorta in a typical patient and is consequently a first-order catheterization.

Medical Billing and Coding Tip: Due to these anatomical differences, the proper code for a right common carotid cath placement, as described in the above scenario, is second order CPT 36216 (Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family).

Alternatively, for a left common carotid cath placement, you would report first-order code 36215 (…each first order thoracic or brachiocephalic branch, within a vascular family) for a patient who has a normal anatomy.