How To Use CPT Code 36226

CPT 36226 describes the selective catheter placement in the vertebral artery, along with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 36226?

CPT 36226 can be used to describe the procedure in which a provider performs imaging supervision and interpretation for angiography of the ipsilateral vertebral circulation. This involves inserting a catheter through a distal artery into the thoracic aorta and aortic arch, injecting contrast material, and taking X-ray images to detect any vascular disease.

2. Official Description

The official description of CPT code 36226 is: ‘Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed.’

3. Procedure

1. The provider places a needle in the artery of an extremity and threads a guidewire through the needle into an artery.
2. Using the guidewire, the provider advances into the thoracic aorta and moves into the arch of the aorta.
3. A catheter is then inserted into the vertebral artery.
4. The provider injects contrast material through the catheter into the blood circulation.
5. Multiple X-ray images are taken as the contrast material flows through the ipsilateral vertebral circulation and cervicocerebral arch.
6. After imaging, the catheter is removed and pressure is applied to stop bleeding from the incision site.

4. Qualifying circumstances

CPT 36226 is performed when there is a need for selective catheter placement in the vertebral artery, along with angiography of the ipsilateral vertebral circulation. This procedure is typically done to detect any vascular disease in the vertebral artery or cervicocerebral arch. It is important to note that this code is specific to unilateral placement and angiography.

5. When to use CPT code 36226

CPT code 36226 should be used when a provider performs selective catheter placement in the vertebral artery, along with angiography of the ipsilateral vertebral circulation. This code is appropriate when the procedure is performed unilaterally. If the procedure is performed bilaterally, a different code should be used.

6. Documentation requirements

To support a claim for CPT 36226, the provider must document the following information:

• Indication for the procedure and the need for selective catheter placement and angiography
• Details of the procedure, including the specific arteries accessed and the use of contrast material
• Date and time of the procedure
• Findings from the angiography, including any abnormalities or vascular disease detected
• Any complications or adverse events that occurred during or after the procedure
• Signature of the provider performing the imaging supervision and interpretation

7. Billing guidelines

When billing for CPT 36226, ensure that the procedure meets the criteria for selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation. It is important to use the appropriate code for unilateral placement and angiography. If the procedure is performed bilaterally, a different code should be used. Additionally, follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 36226 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 provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to evaluate a patient with suspected vertebral artery stenosis.
2. During a diagnostic workup, a provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to assess the blood flow in a patient with a history of cerebrovascular disease.
3. A provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to identify any vascular abnormalities in a patient with recurrent vertigo.
4. As part of a preoperative evaluation, a provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to assess the blood supply to the brain in a patient undergoing a complex surgical procedure.
5. A provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to evaluate the extent of vascular malformation in a patient with a known arteriovenous malformation.
6. During a stroke workup, a provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to assess the blood flow and detect any occlusions or stenosis in the vessels.
7. A provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to evaluate a patient with persistent headaches and suspected vascular abnormalities.
8. As part of a research study, a provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to gather data on the prevalence of vascular anomalies in a specific population.
9. A provider performs selective catheter placement in the vertebral artery and angiography of the ipsilateral vertebral circulation to assess the blood flow and detect any abnormalities in a patient with unexplained neurological symptoms.