Q & A with Dr. David Zielske

Question: Vertebral Imaging for Lt. subclavian steal

We imaged a patient for left subclavian steal syndrome. After imaging the aortic arch, the right vertebral artery was selected and imaged. The radiologist described the right vertebral artery, the posterior cerebral circulation, then the flow of contrast back down the left vertebral artery and into/through the left subclavian artery. In the past, we would have been able to code this as bilateral vertebral injections. Can we still do this with the 2013 rules? Technically, the left vertebral injection was selective, but it was selective from the right. So I am not sure if it would be correct to code this as 36226 or 36226-50. Which do you recommend? Thank you for your help.


Since the new codes include both selective catheterization of the vessel and imaging of the vessel, we do not recommend coding 36226 again for the contralateral vertebral that is imaged (only) in a retrograde fashion from injecting the other vertebral.  We only code 36226 once here.