How To Use CPT Code 36223

CPT 36223 describes the procedure of selective catheter placement in the common carotid or innominate artery, along with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36223?

CPT 36223 is used to describe the procedure of selective catheter placement in the common carotid or innominate artery, along with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation. This code represents the imaging supervision and interpretation performed by a healthcare provider during the angiography procedure.

2. Official Description

The official description of CPT code 36223 is: ‘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.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the site over a peripheral artery, typically the femoral artery.
2. A needle is used to puncture the site and a guidewire is inserted into the artery.
3. The guidewire is threaded into the thoracic aorta and then into the branch of the aortic arch.
4. A catheter is inserted into the common carotid or innominate artery.
5. The guidewire is removed and contrast material is injected into the artery.
6. The healthcare provider performs angiography, taking X-ray images of the intracranial carotid, extracranial carotid, and cervicocerebral arch as the contrast material flows through these blood vessels.
7. After imaging, the catheter is removed and pressure is applied to stop bleeding from the incision site.

4. Qualifying circumstances

CPT 36223 is performed on patients who require selective catheter placement and angiography of the common carotid or innominate artery. This procedure is used to detect vascular diseases in the intracranial or extracranial carotid circulation. It is important to note that CPT 36223 should not be reported in conjunction with codes 37215, 37216, or 37218 for the treated carotid artery.

5. When to use CPT code 36223

CPT code 36223 should be used when a healthcare provider performs selective catheter placement in the common carotid or innominate artery, along with angiography of the ipsilateral intracranial carotid circulation. This code represents the imaging supervision and interpretation component of the procedure.

6. Documentation requirements

To support a claim for CPT 36223, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for selective catheter placement and angiography
• Specific details of the procedure, including the approach used and any associated angiography performed
• Date and duration of the procedure
• Findings from the angiography, including any abnormalities or vascular diseases detected
• Signature of the healthcare provider performing the imaging supervision and interpretation

7. Billing guidelines

When billing for CPT 36223, ensure that the procedure is performed by a qualified healthcare provider and that the imaging supervision and interpretation component is documented. It is important to note that CPT 36223 should not be reported in conjunction with codes 37215, 37216, or 37218 for the treated carotid artery. Medicare guidelines also recommend appending modifier 26 to the code to report only the professional component.

8. Historical information

CPT 36223 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs selective catheter placement in the common carotid artery and angiography of the ipsilateral intracranial carotid circulation to detect any vascular abnormalities.
2. During the procedure, the healthcare provider identifies a blockage in the extracranial carotid artery and performs angiography to further evaluate the condition.
3. A patient with a history of stroke undergoes selective catheter placement in the innominate artery and angiography of the ipsilateral intracranial carotid circulation to assess the blood flow in the brain.
4. Using CPT 36223, a healthcare provider performs imaging supervision and interpretation for a patient with suspected vascular disease in the common carotid artery.
5. A healthcare provider performs selective catheter placement in the common carotid artery and angiography of the ipsilateral intracranial carotid circulation to evaluate the effectiveness of a previous intervention.