Radiology Coding Alert

Question: Should I report one unit or two units for an Onyx^® embolization of bilateral middle meningeal arteries for treatment of bilateral arteriovenous malformations?

Utah Subscriber

Answer: Onyx^® embolization therapy is used as an effective treatment for arteriovenous malformations (AVMs) and chronic subdural hematomas, among other cerebrovascular conditions.

You may report this procedure using CPT^® code 61624 (Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; central nervous system (intracranial, spinal cord)). However, you’ll want to take a few factors into consideration in order to get all the details correct.

You may notice that 61624 has a bilateral surgery indicator of “0.” This means that it’s not eligible for bilateral billing. However, that doesn’t mean that you should only code 61624 as one unit if the surgeon performs the procedure on bilateral sites. You should also take note that 61624 has a medically unlikely edit (MUE) of 2, which indicates that on any given date of service (DOS), you may code for no more than two units of 61624.

This means that instead of attempting to submit one unit of 61624 with modifiers LT (Left Side) and RT (Right Side) or 50 (Bilateral Procedure), you should submit two units of 61624 without either of the aforementioned bilateral-indicting modifiers.

In addition to 61624, you should also be reporting 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation) if and when the same provider performs the supervision and interpretation of the embolization therapy. Lastly, you’ll want to evaluate the report to determine whether the surgeon performs a follow-up angiography through the already-present embolization catheter. If so, you may report 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis) in addition to 61624 and 75894. A National Correct Coding Initiative (NCCI) edits check reveals no edits between these three services, which means no overriding modifiers are required.