CPT® Code 61642 | Case2Code

Official Description

Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (List separately in addition to code for primary procedure)

Common Language Description

Balloon dilatation of intracranial vasospasm is a specialized endovascular procedure aimed at alleviating vasospasm, which is the constriction of blood vessels due to the smooth muscle lining's abnormal contraction. This condition often arises following a subarachnoid hemorrhage, where blood leaks into the space surrounding the brain, leading to changes in the vessel's intima. These changes can result in narrowing and rigidity of the vessel wall, impeding blood flow and potentially causing serious complications. The procedure involves a series of carefully orchestrated steps, beginning with the preparation of the access site, where the skin is cleansed and a local anesthetic is administered to minimize discomfort. A small incision is made to access the blood vessel, allowing for the insertion of a needle followed by a sheath. Through this sheath, a microcatheter or neurointerventional guidewire is navigated from the access artery into the carotid circulation, targeting the specific intracranial artery affected by vasospasm. Once the artery is selectively catheterized, diagnostic arteriography is performed to assess the vascular anatomy and confirm the need for balloon dilatation. If indicated, the procedure continues with the placement of a balloon catheter across the arterial lesion, which is then inflated under fluoroscopic guidance to dilate the narrowed segment. This intervention is critical for restoring normal blood flow and preventing further neurological deficits. The code 61642 specifically refers to the balloon dilatation of each additional vessel in a different vascular territory, performed in conjunction with the primary procedure, ensuring accurate coding and billing for the services rendered.

1. Indications

The procedure of balloon dilatation of intracranial vasospasm is indicated for the following conditions:

Vasospasm following subarachnoid hemorrhage - This condition occurs when blood leaks into the subarachnoid space, leading to the abnormal contraction of the smooth muscle lining of the blood vessels, resulting in reduced blood flow.

2. Procedure

The balloon dilatation procedure involves several critical steps to ensure effective treatment of the vasospasm:

Step 1: Preparation of the access site - The skin over the catheter access site is thoroughly cleansed to reduce the risk of infection. A local anesthetic is then injected to numb the area, ensuring patient comfort during the procedure.
Step 2: Accessing the blood vessel - A small stab incision is made in the skin, and a needle is inserted into the targeted blood vessel. Following this, a sheath is placed to facilitate the introduction of further instruments.
Step 3: Navigation to the carotid circulation - A microcatheter or neurointerventional guidewire is carefully threaded from the access artery into the carotid circulation, allowing for precise targeting of the intracranial artery affected by vasospasm.
Step 4: Selective catheterization - The specific intracranial artery to be treated is selectively catheterized by advancing an arteriography catheter over the guidewire, enabling access to the site of the vasospasm.
Step 5: Diagnostic arteriography - A diagnostic arteriography is performed to evaluate the vascular anatomy and confirm whether balloon dilatation is necessary. This step is crucial for determining the appropriate treatment approach.
Step 6: Balloon catheter preparation - If balloon dilatation is indicated, additional angiograms are obtained to assess the arterial lesion and determine the proper placement and diameter of the balloon catheter.
Step 7: Advancing the balloon catheter - A steerable micro-guidewire and microcatheter are advanced through the guide catheter into the intracranial arteries and across the arterial lesion. The micro-guidewire is then removed and replaced with an exchange wire to facilitate the next steps.
Step 8: Inflation of the balloon - The microcatheter is removed, and the angioplasty balloon catheter is advanced over the exchange wire and positioned across the lesion. The balloon is inflated under fluoroscopic control, effectively dilating the arterial lesion.
Step 9: Post-inflation evaluation - Once adequate dilatation is achieved, the balloon catheter is withdrawn into the access artery but not completely removed. The guidewire remains in place while post-procedure angiograms are obtained to check for hyperacute thrombosis or rebound stenosis.
Step 10: Conclusion of the procedure - If any complications arise, additional interventional measures are initiated. After successfully dilating the arterial lesion and addressing any issues, the catheters and guidewires are removed, completing the procedure.

3. Post-Procedure

After the balloon dilatation procedure, careful monitoring is essential to assess for any immediate complications such as hyperacute thrombosis or rebound stenosis. Post-procedure angiograms are performed to evaluate the success of the intervention and ensure that normal blood flow has been restored. Patients may require additional interventions if complications are detected. Recovery protocols will vary based on individual patient needs and the extent of the procedure performed, but close observation is typically warranted to ensure optimal outcomes.

Short Descr	DILAT IC VSPSM EA DIFF TER
Medium Descr	PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER
Long Descr	Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (List separately in addition to code for primary procedure)
Status Code	Non-Covered Service
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P1G - Major procedure - Other
MUE	0
CCS Clinical Classification	59 - Other OR procedures on vessels of head and neck

This is an add-on code that must be used in conjunction with one of these primary codes.

61640	MPFS Status: Non-covered Service APC E1 CPT Assistant Article Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel
69990	Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)