Neurosurgery Coding Alert

Question: The surgeon establishes access and advances the catheter into the right common carotid and then the right internal carotid for imaging. Following imaging, the surgeon administers nicardipine infusion into the right internal carotid artery. Which CPT® codes should we report for this procedure?

Wyoming Subscriber

Answer: For this procedure, you will report code 61650 (Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory). You should not submit any codes for diagnostic angiography since this service is included in code 61650.

If, however, the surgeon further advanced the catheter into the left common carotid, followed by the left internal carotid for imaging, and then he performed an infusion of nicardipine in the left internal carotid artery, you would report codes 61650 and +61651 (… each additional vascular territory (List separately in addition to code for primary procedure)). Code 61650 covers the imaging and infusion services in the right internal carotid artery, and code +61651 covers the services in the left internal carotid artery.

Don’t miss: Codes 61650 and +61651 are specific to intracranial infusions that use non-thrombolytic agents. These include infusions of vasodilators or chemotherapeutic agents. Codes 61650 and +61651 do not apply to the routine administration of saline or anticoagulants like heparin during these interventions.