How To Use CPT Code 36224

CPT 36224 describes the procedure of selective catheter placement in the internal carotid artery, along with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36224?

CPT 36224 can be used to describe the procedure of selective catheter placement in the internal carotid artery, along with angiography of the ipsilateral intracranial carotid circulation and associated radiological supervision and interpretation. This code is used when a healthcare provider inserts a catheter through a distal artery, typically the femoral artery, and advances it into the thoracic aorta and further into the internal carotid artery. Contrast material is then injected to obtain X-ray images of the intracranial or extracranial arteries, as well as the cervicocerebral arch, to detect any vascular disease.

2. Official Description

The official description of CPT code 36224 is: ‘Selective catheter placement, internal carotid artery, unilateral, 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 and administers anesthesia.
2. A needle is used to puncture the site over a peripheral artery, typically the femoral artery.
3. A guidewire is inserted through a sheath in the needle and into the artery.
4. The needle is removed, and the provider threads the wire into the thoracic aorta and then into the branch of the aortic arch.
5. A catheter is inserted into the internal carotid artery, and the wire is removed.
6. Contrast material is injected into the artery, and X-ray images are taken of the intracranial, carotid, and extracranial arteries, as well as the cervicocerebral arch.
7. After imaging, the catheter is removed, and pressure is applied to stop bleeding from the incision site.

4. Qualifying circumstances

CPT 36224 is performed when there is a need for selective catheter placement in the internal carotid artery, along with angiography of the ipsilateral intracranial carotid circulation. It is typically done to detect and evaluate vascular diseases in the intracranial or extracranial arteries. This procedure should not be reported in conjunction with codes 37215, 37216, or 37218 for the treated carotid artery.

5. When to use CPT code 36224

CPT code 36224 should be used when a healthcare provider performs selective catheter placement in the internal carotid artery and conducts angiography of the ipsilateral intracranial carotid circulation. It is important to note that this code should not be reported with codes 37215, 37216, or 37218 for the treated carotid artery.

6. Documentation requirements

To support a claim for CPT 36224, the healthcare provider must document the following information:

• Reason for the procedure and the need for selective catheter placement
• Specific details of the angiography performed, including the arteries imaged
• Date and duration of the procedure
• Contrast material used
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 36224, ensure that the procedure meets the criteria for selective catheter placement in the internal carotid artery and angiography of the ipsilateral intracranial carotid circulation. It is important to note that this code should not be reported with codes 37215, 37216, or 37218 for the treated carotid artery. Additionally, Medicare does not pay hospitals separately for supervision and interpretation codes deemed to be ancillary and supportive services to primary diagnostic or therapeutic services.

8. Historical information

CPT 36224 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 internal carotid artery and conducts angiography of the ipsilateral intracranial carotid circulation to evaluate a patient with suspected cerebrovascular disease.
2. During a diagnostic procedure, a healthcare provider inserts a catheter into the internal carotid artery and performs angiography of the ipsilateral intracranial carotid circulation to assess the extent of a patient’s carotid artery stenosis.
3. A patient with a history of stroke undergoes selective catheter placement in the internal carotid artery and angiography of the ipsilateral intracranial carotid circulation to identify any vascular abnormalities.