The year is swiftly flying by meaning coding errors can multiply in volume over time costing your facilities dollars every single day. Arch, carotid, and vertebral angiography remain integral components of head and neck interventional radiology coding. As we move deeper into 2025, this area continues to present challenges significant enough to merit focused review and expert analysis. Diagnostic cervicocerebral angiography requires the assignment of comprehensive CPT® codes that encompass both catheterization and imaging—making accuracy essential. The complexity lies in the intricate nuances of code selection, including vessel access, imaging scope, and hierarchy. In this month’s IR coding spotlight, we examine CPT® codes 36221–36224, offering updated insights to help you navigate these procedures with precision and confidence in 2025.
Growing an Understanding of the Coding Family Tree
1).First, know that code 36221 describes the arch study. Unless otherwise instructed by a payer, if the same procedure is performed on both sides, assign the appropriate code once with modifier 50. If different procedures are performed, assign the individual codes with modifiers RT and LT.
2). How do you choose the appropriate code? The key is to identify the final catheter placement as well as the vessels that were imaged. However, do not assign separate codes for imaging of the vessels included within the code’s descriptor.
3).It is important to note that codes 36215, 36216, 36217, or 36218 cannot be used for head or neck catheterization when a diagnostic angiogram is also performed. Codes 36222–36228 describe unilateral procedures. These codes are also unchanged regardless of the initial vascular access point. Coders may be wondering about when anomalies impact coding selection. Vascular anomalies such as a bovine arch do not change the coding for these diagnostic exams.
| 36221 | Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed |
4).CPT® code 36221 is assigned for what is commonly called an arch study. What is involved in this study? The study is an examination of the carotid and vertebral arteries from a non-selective catheterization of the thoracic aorta. In the carotid and vertebral diagrams on the following pages, the dot(s) indicate possible catheter locations while the arteries colored gray indicate the possible imaging for each code.
5). If the descending thoracic aorta is imaged other than during a carotid/vertebral diagnostic exam, such as during an extremity angiogram, code 75600 or 75605 (even if arch is included).
6).Assign code 36221 if no further selective catheterization and imaging is performed for carotid and/or vertebral diagnostic imaging.
| 36222 | Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed |
| 36223 | Selective catheter placement, common carotid or innominate artery, unilateral, any approach, 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 |
| 36224 | 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 |
7). Codes 36222–36224 are assigned for diagnostic carotid angiography. Choose only one code per side. It is important to know that these codes are built on a hierarchy; that is, each code is built on and includes the imaging designated in the lesser codes, including arch exam 36221. So, therefore, code 36224 includes all the work of 36221, 36222, and 36223. Code 36223 includes all the work of 36221 and 36222. Code 36222 includes all the work of 36221.
⚠️ Your 2025 IR Coding Remains Under Threat, Creating Significant Risk to Your Bottom Line. These Are NOT All the Tips and Tricks Necessary for Success.
With every dollar of reimbursement counting more than ever in the face of payment decline and complex changes, it’s imperative to make sure your CPT® coding is correct and compliant. Master more coding topics and break down the complexity with our 2025 Head and Neck Interventional Radiology Coding on July 9, 2025 at 11:00 am CT (120 minutes).
