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The procedure described by CPT® Code 61650 involves the endovascular intracranial prolonged administration of pharmacologic agents, specifically excluding thrombolysis. This procedure is primarily aimed at treating conditions such as arterial vasospasm that may occur following a stroke. The pharmacologic agents utilized in this context may include medications like papaverine, nicardipine, and verapamil, which are known for their effectiveness in alleviating vasospasm by relaxing the blood vessels. The access to the intracranial blood vessels is achieved through a peripheral artery, which allows for a minimally invasive approach to deliver the necessary treatment directly to the affected area. The procedure is guided by fluoroscopy, a real-time imaging technique that ensures accurate placement of instruments within the vascular system. The process begins with the introduction of a needle into the artery, followed by the advancement of a thin wire to the targeted vascular area. If diagnostic angiography is indicated, a catheter is placed over the guidewire to visualize the intracranial blood vessels using contrast dye. This imaging step is crucial for assessing the vascular anatomy and confirming the presence of vasospasm. After obtaining the necessary images, the guidewire is reinserted, and the angiography catheter is removed. Subsequently, an infusion catheter is introduced to deliver the pharmacologic agent as a prolonged continuous infusion to the targeted vascular territory. This procedure may also allow for the movement of the catheter to access additional vascular territories, facilitating the delivery of pharmacologic agents as needed. Overall, this code encompasses the entire process, including diagnostic angiography and imaging guidance, ensuring comprehensive treatment for patients experiencing arterial vasospasm.
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The procedure described by CPT® Code 61650 is indicated for the treatment of arterial vasospasm, particularly following a stroke. This condition can lead to significant complications, including reduced blood flow to the brain, which may result in further neurological deficits. The pharmacologic agents administered during this procedure are specifically chosen for their ability to relax the blood vessels and improve blood flow, thereby alleviating the symptoms associated with vasospasm. The use of this procedure is critical in managing patients who exhibit signs of vasospasm and require immediate intervention to restore adequate cerebral perfusion.
The procedure begins with the establishment of access to the intracranial blood vessels through a peripheral artery. This is achieved by introducing a needle into the artery under fluoroscopic guidance, which allows for real-time imaging to ensure accurate placement. Once the needle is in position, a thin wire is threaded through the needle and advanced to the targeted vascular area where the pharmacologic agent will be administered. If diagnostic angiography is warranted, a catheter is then introduced over the guidewire, and the guidewire is subsequently removed. Contrast dye is injected through the catheter to obtain detailed images of the intracranial blood vessels, which is essential for assessing the vascular anatomy and confirming the presence of any abnormalities, such as vasospasm. After the angiography is completed, the guidewire is reinserted to maintain access to the vascular territory, and the angiography catheter is removed. Following this, an infusion catheter is introduced over the guidewire and advanced to the targeted vascular territory. The pharmacologic agent is then delivered as a prolonged continuous infusion, which is crucial for effectively treating the vasospasm. The infusion may be adjusted to access additional vascular territories if necessary, allowing for the delivery of pharmacologic agents to multiple areas before the catheter is finally removed at the end of the treatment period. This comprehensive approach ensures that the procedure addresses the specific needs of the patient while providing critical diagnostic information through angiography.
After the completion of the procedure, patients are typically monitored for any immediate complications or adverse reactions to the pharmacologic agents administered. It is essential to assess the patient's neurological status and ensure that there are no signs of further vasospasm or other complications. The recovery process may vary depending on the individual patient's condition and the extent of the procedure performed. Follow-up imaging may be required to evaluate the effectiveness of the treatment and to monitor the patient's progress. Additionally, healthcare providers may implement supportive care measures to manage any symptoms and facilitate recovery. Proper documentation of the procedure and the patient's response is crucial for ongoing care and future treatment planning.
| Short Descr | EVASC PRLNG ADMN RX AGNT 1ST | Medium Descr | EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST | Long Descr | Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory 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.
| 61651 | Add-on Code MPFS Status: Active Code APC C 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) | 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) |
| 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. | 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). | 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. | 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.) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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 | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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