# 61623 & 61624? Balloon occlusion & embolization



## margaret fahy (Mar 6, 2015)

Hey Guys,
Is 61623 included in 61624?  CSI book doesn't state so, and they're not bundled.
Procedure is below....can someone tell me if I am to bill 61623 when it is done in same session as 61624?
PROCEDURE: Cerebral angiogram, left internal carotid artery

balloon occlusion test, and embolization of left



internal carotid artery.



HISTORY: 17-year-old with traumatic left cervical internal

carotid artery pseudoaneurysm.

VESSELS SELECTED:



Left internal carotid artery



Left common carotid artery



 TECHNIQUE:

After informed consent the patient was brought into the

angiography suite and placed supine on the angiographic table.

The right groin was prepped and draped using sterile technique.

The CHOP Interventional Radiology service, Dr.  obtained

access to the right femoral artery using ultrasound guidance and

placed a 6-French sheath. Using an 0.038" Glide Wire and 6-French

Envoy catheter, the above vessels were selectively catheterized

for angiography

 FINDINGS:



LEFT COMMON CAROTID ARTERY AND LEFT INTERNAL CAROTID ARTERY

INJECTIONS, HEAD AND NECK VIEWS: Redemonstrated left cervical

internal carotid artery (ICA) pseudoaneurysm extending from the

proximal cervical ICA to the skull base, unchanged compared to

cerebral angiogram of 2/13/2015. Unremarkable angiographic

appearance of the left supraclinoid internal carotid artery, left

middle cerebral artery, and left anterior cerebral artery. The

angiogram has normal parenchymal and venous phases. No evidence

of high grade focal intracranial stenosis or vascular

malformation.


An intervention was performed as follows.



INTERVENTION:



BALLOON OCCLUSION TEST:



The patient was fully anticoagulated with IV heparin, confirmed

by ACT levels, throughout balloon occlusion test. The 6F Envoy

catheter was positioned in the proximal left cervical ICA. An

Expedion 0.010 wire and Hyperform 7 x 7 mm balloon were prepared

using standard technique and advanced into the proximal left

cervical internal carotid artery just proximal to the

pseudoaneurysm. Under real-time fluoroscopy, the balloon was

inflated. Gentle injection through the guide catheter confirmed

occlusion of the left internal carotid artery. Serial neurologic

exams were performed every minute for 20 minutes. The patient's

neurologic exam was unchanged during 20 minutes of left internal

carotid artery balloon occlusion. Intermittent fluoroscopy was

performed to confirm that the balloon was inflated during the

procedure. At the conclusion of the ballon occlusion test, the

ballon catheter was deflated and removed. Neurological

examination following the balloon occlusion test remained normal.



LEFT INTERNAL CAROTID ARTERY EMBOLIZATION:



The left cervical ICA pseudoaneurysm selected with a SL-10

microcatheter and Synchro-2 microwire system. Embolization was

performed across the pseudoaneurysm into the proximal left

cervical ICA, proximal to the pseudoaneurysm. Platinum coils

(delivered through the SL-10 microcatheter) and Amplatzer

vascular plugs (delivered through the 6-French Envoy catheter)

were deployed under continuous fluoroscopic guidance.



The following coils and Amplatzer vascular plugs were deployed:



Target 360 Standard 15 mm x 40 cm



Target 360 Standard 15 mm x 40 cm



Target 360 Standard 12 mm x 30 cm



Target 360 Standard 12 mm x 30 cm



Target 360 Standard 10 mm x 30 cm



Target 360 Standard 10 mm x 30 cm



Amplatzer vascular plug 6mm



Amplatzer vascular plug 6mm



Target 360 Soft 5 mm x 15 cm



Target 360 Ultra 3 mm x 8 cm



Target 360 Ultra 3 mm x 8 cm



Target 360 Soft 3 mm x 10 cm



Post embolization angiography demonstrated no antegrade flow

through the embolized portions of the left ICA. There is

antegrade filling of the supraclinoid ICA via ECA-ophthalmic

collaterals. There is minimal contrast opacification of the left

cavernous ICA, which will most likely be occluded over time due

to slow flow.



At the completion of the procedure, the catheter and sheath were

removed and hemostasis in the right groin obtained by manual

compression for 20 minutes.



No new neurological deficits or complications were encountered

during or immediately following the procedure.

 IMPRESSION

Successful occlusion of the left internal carotid artery after

negative balloon occlusion test as detailed.


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## s_harris14 (Mar 24, 2015)

I am looking for the same answer. My NIR performed a balloon test occlusion (61623) in the same session as coil embolization (61624) for a pseudoaneurysm secondary to carotid artery dissection. Amerigroup denied our claim stating the codes are mutually exclusive, but I can't find any NCCI edit or information in the Dr. Z IR coding reference to support their decision.


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## margaret fahy (Mar 25, 2015)

Hi,
I got this answer from Jim Pawloski on this site.

Found in Dr. Z's cardiovascular book, If Carotid test occlusion is followed by permanent occlusion, bill both procedures. So you have 61623, 61624, 75894, 75898. You can bill as many post angio runs that are documented.

I billed for both 61623 and 61624.


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## s_harris14 (Apr 1, 2015)

Thanks! To add & confirm - I just found a recent Medicare claim where 61623 and 61624 were paid together without incident. I'm off to appeal our Amerigroup claim! 

Stephanie


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## rmelissa (Apr 18, 2017)

margaret fahy said:


> Hi,
> I got this answer from Jim Pawloski on this site.
> 
> Found in Dr. Z's cardiovascular book, If Carotid test occlusion is followed by permanent occlusion, bill both procedures. So you have 61623, 61624, 75894, 75898. You can bill as many post angio runs that are documented.
> ...



Thank you so much! I've been pouring over the Dr. Z book for IR coding, and it never referenced this!


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## Jim Pawloski (Apr 24, 2017)

rmelissa said:


> Thank you so much! I've been pouring over the Dr. Z book for IR coding, and it never referenced this!



Look in Dr. Z's Interventional Radiology Coding pg. 258, bullet #29, or in Diagnostic & Interventional Cardiovascular Coding pg. 382, bullet 34. That's where you will find Dr. Z's comment (Neurointerventions).

Margaret, thanks for remembering what I had posted.

Have a great day everyone,
Jim Pawloski, CIRCC


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