Head and Neck Angiography Coding in Interventional Radiology: Key Tips for 2025

As interventional radiology (IR) continues to evolve, accurate coding remains critical—not only for compliance but also for maximizing reimbursements and avoiding costly errors. Head and neck-related angiography, including arch, carotid, and vertebral studies, is a particularly complex area that requires a deep understanding of CPT® code hierarchies and proper documentation practices.

With 2025 well underway, now is the perfect time to sharpen your knowledge of cervicocerebral angiography coding. This article takes a deep dive into CPT® codes 36221–36224 and the common pitfalls associated with them—ensuring you stay ahead of denials and deliver clean claims every time.

Why Precision Matters in Cervicocerebral Angiography Coding

Head and neck angiography procedures often involve both catheterization and imaging, and each element must be captured accurately using the correct CPT® codes. Errors in reporting—even small ones—can lead to audits, delays in payment, and underreporting of services rendered. The most common issues arise from:

• Misinterpreting catheter placement
• Failing to apply the coding hierarchy
• Overcoding overlapping imaging work
• Improper use of modifiers for bilateral procedures

Understanding the CPT® Code Family: 36221–36224

Let’s break down the key cervicocerebral angiography codes and the coding logic behind them.

CPT® 36221 – The Arch Study

Code Description:

Non-selective catheter placement in the thoracic aorta with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, including all associated radiological supervision and interpretation.

When to Use It:

• When no selective catheterization is performed beyond the thoracic aorta.
• When imaging includes the arch and its branches (e.g., carotid and vertebral vessels) without advancing the catheter further into specific arteries.

Pro Tip:

This code is often assigned when a general overview (or roadmap) of the aortic arch and its major branches is needed before proceeding with selective interventions.

Avoid This Mistake:

Do not report 36221 in combination with 36222–36224 on the same side. These higher-level codes already include the arch study.

CPT® 36222–36224 – Selective Angiography Codes

These codes describe progressively deeper catheter placements and more detailed imaging.

Built-In Hierarchy:

• 36224 includes all the work of 36223, 36222, and 36221
• 36223 includes 36222 and 36221
• 36222 includes 36221

How to Choose Correctly:

• Identify the final catheter position
• Confirm the extent of imaging performed
• Report only one code per side based on the highest level of work

Example:

If the catheter is selectively placed in the internal carotid artery and imaging is performed of the intracranial vessels, report 36224—not 36221, 36222, or 36223.

Modifier Tips for Laterality and Bilateral Studies

• Use modifier 50 if the same procedure is performed bilaterally (e.g., 36224-50).
• Use modifiers LT and RT when different procedures are performed on each side (e.g., 36222-RT and 36223-LT).

Payer Variation Warning:

Always confirm bilateral reporting guidelines with individual payers, as requirements may vary.

Special Scenarios and Clarifications

Imaging of the Descending Thoracic Aorta

If imaging is performed on the thoracic aorta unrelated to a cervicocerebral diagnostic exam, use:

• 75600 – Aortogram without fluoroscopy
• 75605 – Aortogram with fluoroscopy

Bovine Arch and Vascular Variants

Anatomical anomalies like a bovine arch do not change CPT® code selection. Coding is still based on catheter location and imaging scope, not vessel configuration.

Avoid Misuse of Catheter Placement Codes

Do not use 36215–36218 in combination with 36222–36224 for the same side. Catheter placement is already bundled into those diagnostic codes.

Final Thoughts: Code with Confidence

Accurate coding for head and neck angiography is a blend of anatomy knowledge, procedural insight, and CPT® familiarity. By understanding how the code hierarchy works, where the catheter is placed, and what was imaged, coders can make accurate code selections that reflect the full scope of the radiologist’s work.

Key Takeaways:

• CPT® 36221 is for non-selective arch imaging only.
• CPT® 36222–36224 are hierarchical and include the work of lower codes.
• Only one code per side should be billed based on the highest level of service.
• Always use appropriate modifiers for bilateral or side-specific procedures.

Bonus: Quick Reference Chart

Partnering for Accuracy: Elevate Your Radiology Coding with Expert Support

Coding for interventional radiology—especially head and neck angiography—is a high-stakes, detail-driven process. Between navigating CPT® hierarchies, applying correct modifiers, and staying updated on payer-specific rules, even experienced coders can find themselves second-guessing code selection.

That’s where we come in.

At Bristol Healthcare Services, we specialize in Radiology Coding Services that take the guesswork out of complex procedures like cervicocerebral angiography. Our team of certified coding experts brings deep knowledge of vascular anatomy, radiology CPT® guidelines, and current payer policies—ensuring every claim is coded accurately, compliantly, and to its full allowable value.

With our radiology coding solutions, you gain:

• Accurate code selection based on procedural details and clinical documentation
• Compliance with CMS and commercial payer rules
• Reduced denial rates and improved first-pass claim acceptance
• Faster reimbursements and stronger revenue cycle performance
• Expert support for audits and coding queries

Whether you're a hospital radiology department, outpatient imaging center, or specialty physician group, we tailor our services to fit your specific workflow and needs—helping you focus on patient care while we handle the coding complexity.

Struggling with radiology coding accuracy? Let us help you simplify the complex.

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