Arch, Carotid and Vertebral Angiography: A Quick Review

The concept behind bundled codes is not new to anyone familiar with coding for interventional radiology procedures, and it’s no surprise that complete codes (including catheterization and imaging) exist for arch, carotid and vertebral angiography–CPT® codes 36221-36228. Like other code sets, these codes are built on a hierarchy, meaning the lower-numbered codes are valued into the higher-numbered codes.

The common mistake specific to this code set comes from thinking within the hierarchical logic we are accustomed to: the lower-numbered code(s) in the series are all valued into the higher-numbered code(s) in the series and submitting two codes from the same series would be incorrect. This is true with this series of codes…to a point.

So, what’s different with this code set? It depends on what’s being imaged. Let’s look at our hierarchy in a different way – even though the primary codes are in the same series, we can view this as two hierarchies based on what’s being imaged.

Carotid Angiography
CodeSelection: Where is the Catheter Placed?Imaged: What was Imaged?
36221Non-selective archArch and great vessels
36222Common carotid/innominateExtra-cranial carotid
36223Common carotid/innominateIntra-cranial carotid
36224Internal carotidIntra-cranial carotid

For the codes concerning carotid imaging, the work of the lower-numbered codes is included in the higher-numbered codes. That is, 36222 includes 36221, 36223 includes 36222 and 36224 includes 36223. The difference, and how the appropriate code is determined, is based on:

  • Where the catheter is placed (common carotid/innominate or internal carotid), and;
  • What is being imaged

Extra-cranial refers to vessels outside of the skull. This may be referred to in the report as imaging of the neck, common carotid, cervical or internal carotid. Intra-cranial refers to vessels inside of the skull. This may be referred to as imaging of the intracranial, head, cavernous portion, MCA, M1 or M2.

CodeSelection: Where is the Catheter Placed?Imaged: What was Imaged?
36221Non-selective archArch and great vessels
36225Subclavian/innominateVertebral
36226Vertebral arteryVertebral

For the codes concerning vertebral imaging, the work of the lower-numbered codes is included in the higher-numbered codes. That is, 36225 includes 36221 and 36226 includes 36225.

The codes for carotid and vertebral angiography all include the arch study (36221) and both series (carotid and vertebral) are built on a hierarchy. The difference here is that the vertebral angiography codes, though higher numbered within the same series, do NOT include carotid angiography.

Diagnostic carotid angiography and diagnostic vertebral angiography are considered to be separate services and MAY be coded together if both are performed. Assuming, of course, that the documentation supports coding for both services.

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Bryan Nordley

Bryan Nordley is a seasoned professional writer, strategist, and researcher with over a decade’s worth of combined experience. Bryan launched his professional health writing career at the University of British Columbia’s Faculty of Medicine, one of the top 30 faculty of medicine programs in the world, working under the School of Public Health as a communications assistant. From there, he expanded his expertise and knowledge into private healthcare and podiatry before taking the role of healthcare writer at MedLearn Media. Bryan is the lead writer for the MedLearn Publishing brand previously producing both the acclaimed radiology and laboratory compliance manager newsletter products, while currently writing the compliance questions of the week which reach over 10,000 subscribers, creating the MedLearn Publishing Insights blogs and collaborating with operations and nationally renowned subject matter experts, in addition to serving as an editor for a variety of MedLearn publications along with marketing initiatives. Bryan continues to keep his pulse on the latest healthcare industry news, analyzing and reporting with strategic insight.

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