The American Medical Association (AMA) has created three CPT codes for the treatment of occluded arterial intracranial vessels. A mechanical thrombectomy and the administration of thrombolytic or non-thrombolytic agent(s) are some of the methods utilized in the treatment of the occluded vessels. With the creation of the new CPT codes are numerous guidelines, new language and new and revised parenthetical notes to assist us in the proper reporting of these codes. The new CPT codes are as follows:
|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)|
|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|
|+61651||Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each additional vascular territory (List separately in addition to code for primary procedure)|
Treatment methods and coding instructions
Treatment of the occlusion of the intracranial artery involves destruction, removal or dissolution of the clot in order to improve blood supply to the area. The intracranial arteries are divided into three vascular territories which include:
- right carotid circulation,
- left carotid circulation, and
- vertebro-basilar circulation.
CPT code 61645 is reported for the revascularization of the intracranial artery(ies) by any method including mechanical thrombectomy, which is accomplished with the use of devices inserted through a catheter in order to break up and remove the clot from the affected vessel(s) or the infusion of drugs (thrombolysis) in order to dissolve the clot and improve blood flow to the area.
CPT codes 61650 and 61651 would be reported for prolonged therapeutic administration of non-thrombolytic agent(s) such as spasmolytics or chemotherapy. This method is performed to treat non-iatrogenic (not resulting from physician treatment) central nervous system (CNS) diseases or sequelae (condition following and/or resulting from a disease), by infusing drugs into the affected vessel(s). According to the instructions listed in the CPT codebook these codes should not be used to report the administration of agents such as, heparin, nitroglycerin, and saline. These CPT codes should be reported for prolonged administration of at least 10 minutes continuous or intermittent duration.
- Selective catheterization
- Diagnostic angiography
- All subsequent angiography including associated radiological supervision and interpretation within the treated vascular territory
- Fluoroscopic guidance
- Neurologic and hemodynamic monitoring of the patient
- Closure of the arteriotomy by manual pressure, an arterial closure device, or suture
- These codes should not be reported in conjunction with 36221, 36226, 36228, 37184, or 37186 for the treated vascular territory.
- CPT code 61645 should not be reported in conjunction with codes 61650 or 61651 for the same vascular distribution
- Diagnostic angiography of a non-treated vascular territory may be reported separately
- CPT codes 61650 and 61651 should not be reported in conjunction with codes 96420, 96422, 96423, 96425 for the same vascular family. These codes (ex., 96420) represent intra-arterial chemotherapy administration.
Please note, CPT code 61645 may be reported once for each intracranial vascular territory treated. CPT code 61650 is reported once for the first intracranial vascular territory treated with prolonged administration of pharmacologic agent(s) and CPT code 61651 would be reported for each additional territory treated during the same session. Additionally, CPT code 61651 may be reported a maximum of two times daily.
It is important to refer to the current CPT codebook for additional coding guidance as there are numerous parenthetical notes and tips listed after the code narrative(s). ■