Table 1

Case examples 1–5 demonstrating coding, RVU balance, and typical reimbursement under the coding prior to 2013

Example #	Case	2012 CPT codes	2012 RVU	2012 Physician work total RVUs	2012 National physician work reimbursement*
1	RICA angiography for follow-up s/p aneurysm coiling ▸ Inject RICA, imaging of brain	36217	6.29	7.60	$405.48
1		75665	1.31	7.60	$405.48
2	3-vessel diagnostic angiography for CTA-negative SAH ▸ Catheter and inject RCCA; see disease in right ICA bifurcation ▸ Keep catheter in RCCA for cerebral angiography ▸ Catheter and inject LCCA; LCCA imaging ▸ No carotid disease; advance into LICA, cerebral angiography ▸ Put catheter in LVA; inject	36216	5.27	13.86	$734.48
		75680	1.66
		75671	1.66
		36216-59-51	2.64
		36216-59-51	1.32
		75685-LT	1.31
3	Diagnostic evaluation for unruptured brain AVM ▸ Catheter into RCCA Cervical angiography ▸ Catheter into RICA Cerebral angiography ▸ RECA selected, cervical and cerebral angiography ▸ LCCA catheterized; cerebral angiography ▸ LVA catheterized and injected	75676	1.31	17.87	$883.36
		75671	1.66
		36217	6.29
		75660	1.31
		36215-59-51	2.34
		36216-59-51 +36218	2.64
		36216-59-51 +36218	1.01
		75685	1.31
4	Follow-up s/p coil embolization of RICA Aneurysm ▸ Inject RCCA; images taken of the cervical carotid and brain ▸ Inject RVA; images taken of the vertebral artery ▸ Inject LCCA; images taken of the cervical carotid and brain ▸ Inject LVA; images taken of the vertebral artery	36217	6.29	18.22	$901.71
		75685	1.31
		36215-59-51	2.34
		75680	1.66
		75671	1.66
		36216-59-51	2.64
		75685-76	1.31
		+36218	1.01
5	Bilateral carotid angiography, superselective intracranial angiography, embolization of right frontal lobe AVM ▸ Inject LCCA; images taken of cervical carotid and brain ▸ Inject RCCA; roadmapping images taken of cervical and intracranial carotid ▸ Inject RICA; images of brain obtained ▸ Inject RACA; images of that vascular territory ▸ Inject two RACA branches ▸ Inject R ophthalmic artery ▸ Embolization of main trunk branch off RACA ▸ Post-embolization injection and imaging of brain	36217-51	3.15	34.95	$1897.86
		75671-59	1.66
		75774-59×3	0.36×3
		36218×2	1.01×2
		75894/75898	1.32, 1.67
		36215-59-51	2.34
		75676-59	1.31
		61624	20.40

RVU totals and reimbursement pricing based on third quarter 2012 CMS Physician Fee Schedule. CMS reduces modifier 51 by 1/2 on the first CPT and pays third CPT code and beyond at 25%. Modifiers 59 and 76 are paid at 100% of the contract allowable, depending on the reason for the modifier. Add-on CPT codes are also paid at 100% of the contract allowable.
*Not including Geographic Practice Cost Indices (GPCIs).AVM, arteriovenous malformation; CPT, current procedural terminology; CTA, CT angiography; ICA, internal carotid artery; LCCA, left common carotid artery; LICA, left internal carotid artery; LVA, left vertebral artery; RACA, right anterior cerebral artery; RCCA, right common carotid artery; RICA, right internal carotid artery; RVA, right vertebral artery; RECA, right external carotid artery; RVU, Relative Value Unit; SAH, subarachnoid hemorrhage; s/p, status-post.