2025 CPT code 36226
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Cardiovascular System Surgery Feed
Selective catheter placement in the vertebral artery (unilateral), with angiography of the ipsilateral vertebral circulation and associated radiological supervision and interpretation; includes angiography of the cervicocerebral arch.
Modifiers such as 52 (reduced services), 59 (distinct procedural service), and 26 (professional component only) may be applicable depending on the circumstances of the procedure and the services rendered.
Medical necessity is established when there is clinical suspicion of vascular disease (e.g., stroke, TIA, head trauma) affecting the vertebral artery or cervicocerebral circulation. The procedure is deemed medically necessary when other non-invasive methods of diagnosis have been deemed insufficient or inconclusive.
The clinical responsibility includes preparing the patient, inserting the needle and guidewire, advancing the catheter to the vertebral artery, injecting contrast material, performing the angiography, removing the catheter, and ensuring hemostasis. The physician also performs the radiological supervision and interpretation of the angiogram.
In simple words: This is an X-ray procedure of the blood vessels in the neck and brain. A thin tube is inserted into an artery, guided to the neck and brain arteries, and a special dye is injected to take X-ray pictures. The doctor watches the procedure and examines the X-rays.
This procedure involves selective catheterization of the unilateral vertebral artery, followed by angiography of the ipsilateral vertebral circulation and the cervicocerebral arch.The code includes all necessary radiological supervision and interpretation. The procedure begins with the placement of a needle into a distal artery, followed by insertion of a guidewire into the thoracic aorta and aortic arch. A catheter is then advanced into the vertebral artery. Contrast material is injected, and X-ray images are obtained to visualize the ipsilateral vertebral circulation and cervicocerebral arch. Following image acquisition, the catheter is removed, and hemostasis is achieved.
Example 1: A patient presents with symptoms suggestive of vertebral artery dissection.This procedure is performed to visualize the vertebral artery and assess the extent of the dissection., A patient with a history of stroke undergoes this procedure to evaluate for the presence of atherosclerotic disease or other vascular abnormalities in the vertebral arteries., A patient with a suspected arteriovenous malformation (AVM) in the cervicocerebral region undergoes this procedure to confirm the diagnosis and assess the AVM's location and size.
Complete medical history, including symptoms, relevant past medical history, and current medications. Pre-procedure consent form signed by the patient.Detailed description of the procedure, including the vessel catheterized, contrast media used, and number of images obtained. Post-procedure notes documenting the patient's condition, any complications, and discharge instructions.Radiology reports and images.
** This code may be used in conjunction with other codes, such as those for radiological supervision and interpretation. Accurate documentation is essential for proper reimbursement.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may be applicable depending on the payer and whether the interpretation is performed by a different physician. The professional component is usually billed with modifier 26.
- Specialties:Vascular Surgery, Interventional Radiology, Neuroradiology
- Place of Service:Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center