2025 CPT code 36228
(Active) Effective Date: N/A Surgical Procedures - Cardiovascular System Surgery Feed
Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (e.g., middle cerebral artery, posterior inferior cerebellar artery).
Modifiers such as 50 (bilateral procedure), 52 (reduced services), 59 (distinct procedural service), 76, 77 (repeat procedures), and others may be applicable depending on the circumstances.
Medical necessity should be established by documenting the clinical indication for the selective catheterization and angiography. This may include suspected stroke, aneurysm, vascular malformation, or other conditions requiring detailed imaging of the intracranial circulation. The documentation must support the need for the additional procedure beyond the primary procedure.
The physician performing the catheter placement, angiography, and radiological supervision and interpretation is responsible for this procedure.It involves placing a needle into an artery, typically in the groin or arm, threading a guidewire through the needle, and then advancing a catheter under imaging guidance to the targeted intracranial artery. Contrast material is injected through the catheter, and x-ray images are taken. The physician also interprets these images.
In simple words: This procedure involves placing a thin tube (catheter) into a specific artery in the brain to take x-ray images of the blood vessels. This helps doctors see the blood flow and identify any problems.
This add-on code describes a procedure where a catheter is placed in each intracranial branch of the internal carotid or vertebral arteries on one side of the head. It includes angiography of the selected vessel circulation and all associated radiological supervision and interpretation.It is used for additional branches like the middle cerebral artery or posterior inferior cerebellar artery, and is reported in addition to the primary procedure code.
Example 1: A patient presents with symptoms suggesting a stroke. A diagnostic angiogram (36224) of the internal carotid artery is performed, revealing a blockage in the middle cerebral artery. To further evaluate this blockage, selective catheterization and angiography of the middle cerebral artery are performed (36228) during the same session., A patient with an aneurysm in the posterior inferior cerebellar artery is undergoing a diagnostic vertebral angiogram (36226). During the procedure, the physician decides to perform additional selective catheterization and angiography of the posterior inferior cerebellar artery (36228) for better visualization., A patient undergoes a neuro-interventional procedure with a primary code such as 36223. In addition to that main procedure, additional selective catheterization of another intracranial branch is performed unilaterally, along with associated angiography and interpretation. This necessitates the use of 36228.
Documentation should include details of the primary procedure, the reason for the selective catheterization of the additional intracranial branch, the artery catheterized, the angiography performed, and the interpretation of the images.Operative reports and radiological findings are crucial.
** Code 36228 is for selective catheter placement and angiography of each additional intracranial branch beyond the primary procedure.It's essential to properly document the medical necessity for the additional catheterizations to ensure appropriate reimbursement.
- Revenue Code: P2F
- Specialties:Interventional Radiology, Neuroradiology, Neurosurgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center