# 61623 and then 61624



## jtuominen (Sep 10, 2010)

Hi there--

anyone run into this? An MD does a Balloon Occlusion Test on the RICA, the results lead him to decide to do a permanent Embolization 61624 of the RICA. Should I charge for both 61623 and 61624? There are no CCI edits bewteen the two codes. Patient is a Medicare Inpatient.


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## msncoder (Sep 10, 2010)

The last article I have on this subject (2003 Insider's View) provides guidance on this specific scenario and states that 61623 would be inherent to the 61624 however the most recent Medlearn IR seminar I attended provided opinion stating that in very rare cases it would be acceptable to bill for both however they stated that extreme caution would need to be used and that you should be prepared for an audit. 
Also, there is a reference to this code in the 14.3 CCI Manual related to this code....which I know is outdated BUT it gives you an idea of what has been discussed on this scenario.
Hope this helps and does not muddy the waters!!!

Here's the excerpt from the article-

*Endovascular intracranial or extracranial temporary vessel occlusion utilizes radiologic imaging to facilitate the placement of an intravascular occlusion device in the vasculature or the head or neck to reversibly occlude blood flow to the brain to demonstrate the feasibility and safety of intentional blockage or unintentional occlusion of a major vascular supply to the brain. Abrupt permanent surgical ligation of extracranial vessels has been performed for many years, but with unpredictable cerebral tolerance and risk of ischemic sequelae (stroke). Gradual occlusion of the internal or common carotid artery utilizing Selverstone or Crutchfield clamp has been performed as an open surgical procedure for more than 30 years in an attempt to decrease ischemic complications. In an attempt to optimize outcomes and decrease ischemic complications, these open surgical techniques have been abandoned in favor of endovascular-surgical procedures. No viable open surgical technique exists to evaluate temporary vertebral artery occlusion by any means other than utilizing endovascular technique


See the 2003 Insider's View for complete information.

Also, the following is from the introductory language of the CCI Manual (14.3) related to this code:

17. CPT code 61623 (endovascular temporary balloon arterial occlusion... concomitant neurological monitoring,...) describes a procedure that includes prolonged neurologic assessment. This code should not be utilized to report the temporary arterial occlusion that is an inherent component of CPT code 61624 (transcatheter permanent occlusion or embolization...; central nervous system (intracranial, spinal cord)). *


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## jtuominen (Sep 13, 2010)

This is great-- Thanks so much!
I can see why they would consider it inherent, but man, the balloon occlusion test is such an extensive procedure in and of itself!
Wonder if the rules will change come 2011, probably will bundle up for sure if so!

Thanks again!


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