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The procedure described by CPT® Code 61645 involves a specialized technique for addressing intracranial blood clots through a minimally invasive approach. This procedure is designed to mechanically remove or dissolve blood clots that obstruct blood flow within the intracranial vessels. The term "percutaneous" indicates that access to the blood vessels is achieved through the skin, typically via a peripheral artery, rather than through an open surgical method. The process begins with the introduction of a needle into the artery, guided by fluoroscopic imaging, which allows for real-time visualization of the blood vessels. A thin wire, known as a guidewire, is then threaded through the needle and navigated to the site of the occlusion. If diagnostic angiography is indicated, a catheter is placed over the guidewire and advanced to the area of blockage. This step is crucial for obtaining detailed images of the intracranial blood vessels, which aids in assessing the extent of the clot and planning the subsequent intervention. After the guidewire is repositioned, a contrast dye is injected to enhance the visibility of the vessels during imaging. Following this, a mechanical device, such as an aspiration catheter or retriever, is utilized to evacuate the clot. In conjunction with mechanical thrombectomy, thrombolytic agents—medications that dissolve clots—may be infused to facilitate the breakdown of the clot. These agents can include tissue plasminogen activator, urokinase, and others, which are delivered through an infusion catheter placed at the clot site. Throughout the procedure, the effectiveness of the treatment is monitored using periodic angiograms to assess clot lysis. The comprehensive nature of this procedure, as encapsulated in CPT® Code 61645, includes all necessary components such as diagnostic angiography, fluoroscopic guidance, catheter placement, and the administration of thrombolytic injections.
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The procedure described by CPT® Code 61645 is indicated for the treatment of various conditions associated with intracranial blood clots. These indications may include:
The procedure for CPT® Code 61645 involves several critical steps to ensure effective treatment of the intracranial blood clot. The first step is the establishment of percutaneous access to the intracranial blood vessel through a peripheral artery. This is achieved by inserting a needle into the artery under fluoroscopic guidance, which provides real-time imaging to assist in accurate placement. Once the needle is in position, a thin guidewire is threaded through the needle and advanced toward the occluded area of the blood vessel. If diagnostic angiography is warranted, a catheter is introduced over the guidewire and navigated to the site of the clot. This allows for the injection of contrast dye, which enhances the visibility of the intracranial blood vessels on imaging studies. After the angiography is completed, the guidewire is carefully removed, and the contrast dye is injected to obtain detailed images of the vascular anatomy and the extent of the occlusion. Following imaging, the guidewire is reinserted and advanced as far as possible through the clot. A mechanical thrombectomy device, such as an aspiration catheter, micro-guidewire, micro-snare, or retriever, is then advanced over the guidewire to the site of the clot. This device is utilized to mechanically evacuate the clot from the blood vessel. In conjunction with the mechanical removal of the clot, an infusion of a thrombolytic agent may be administered to assist in the degradation of the clot. An infusion catheter is placed over the guidewire and directed to the area of the clot, where the thrombolytic medication is delivered either as bolus injections or through continuous infusion. Throughout the procedure, the effectiveness of the thrombolytic therapy is monitored with periodic angiograms to assess the progress of clot lysis. Once the treatment period is complete, the catheter is removed, concluding the procedure.
After the completion of the procedure coded under CPT® Code 61645, patients are typically monitored for any potential complications, such as bleeding or neurological deficits. The recovery process may vary depending on the individual patient's condition and the extent of the clot removal. Patients may require follow-up imaging studies to evaluate the success of the procedure and to ensure that blood flow has been restored adequately. Additionally, post-procedure care may include the administration of anticoagulant medications to prevent future clot formation, along with rehabilitation services if necessary, to support recovery from any neurological deficits resulting from the initial stroke or clot. It is essential for healthcare providers to provide thorough instructions regarding follow-up appointments and any signs or symptoms that should prompt immediate medical attention.
| Short Descr | PERQ ART M-THROMBECT &/NFS | Medium Descr | PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL | Long Descr | 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) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 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) |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | ET | Emergency services | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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