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^® code should I report for this service?

Tennessee Subscriber

Answer: You will report code 61645 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: You would report 61645 when your surgeon either removes (thrombectomy) or does a lysis (thrombolysis) for an intracranial occlusion due to an embolus or a thrombus. You should report 61645 only once for each intracranial vascular territory the surgeon treats, according to CPT^® guidelines.

Additionally, 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,” per the guidelines.

Important: Codes 61645, 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), and +61651 (… each additional vascular territory (List separately in addition to code for primary procedure)) include the following services, so you should not report them separately, according to CPT^® guidelines:

• Selective catheterization
• Diagnostic and any subsequent angiography in the vascular territory
• Radiological supervision and interpretation
• Fluoroscopic guidance
• Neurologic and hemodynamic patient monitoring
• Arteriotomy closure —whether by manual pressure, arterial closure device, or sutures

Exception to the rule: You may separately report diagnostic angiography the surgeon performs in a vascular territory different from the treated vascular territory.