Neurosurgery Coding Alert

Question: The surgeon gained access through the right common femoral artery and advanced a catheter into the right common carotid for imaging. He followed this by imaging the right internal carotid artery and then performed imaging and thrombectomy of the right middle cerebral artery. Which CPT^® should we report for this service?

Louisiana Subscriber

Answer: You should report 61645 (Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)) for these services. The catheterization, angiography, imaging, and the intracranial thrombectomy are all on same side and in the same vascular territory. You should not submit any additional codes for diagnostic angiography. Additionally, the diagnostic imaging is included in 61645.

“Code 61645 describes endovascular revascularization of thrombotic/embolic occlusion of intracranial arterial vessel(s) via any method, including mechanical thrombectomy (eg, mechanical retrieval device, aspiration catheter) and/or the administration of any agent(s) for the purpose of revascularization, such as thrombolytics or IIB/IIIA inhibitors,” according to the CPT^® guidelines.