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The procedure described by CPT® Code 61651 involves the endovascular intracranial prolonged administration of pharmacologic agents, specifically excluding thrombolysis. This procedure is primarily utilized to treat conditions such as arterial vasospasm that may occur following a stroke. The pharmacologic agents that can be administered during this procedure include, but are not limited to, papaverine, nicardipine, and verapamil. These agents are crucial in managing vasospasm by relaxing the blood vessels and improving blood flow to the affected areas of the brain. The access to the intracranial blood vessels is achieved through a peripheral artery, which allows for a minimally invasive approach. The procedure is guided by fluoroscopy, a type of imaging that provides real-time visualization of the blood vessels, ensuring accurate placement of the catheter. The process involves several steps, including the introduction of a needle into the artery, threading a thin wire to the targeted vascular area, and performing diagnostic angiography if necessary. This comprehensive approach not only facilitates the administration of the pharmacologic agents but also includes imaging guidance to monitor the procedure's effectiveness and safety.
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The procedure described by CPT® Code 61651 is indicated for the treatment of arterial vasospasm, particularly following a stroke. This condition can lead to reduced blood flow to the brain, resulting in further neurological damage. The pharmacologic agents administered during this procedure are specifically chosen to alleviate the vasospasm and restore adequate blood circulation to the affected areas. The use of agents such as papaverine, nicardipine, and verapamil is essential in managing this critical condition.
The procedure begins with the establishment of access to the intracranial blood vessels through a peripheral artery. A needle is carefully introduced into the artery under fluoroscopic guidance, which allows for real-time imaging of the vascular structures. Once the needle is in place, 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 indicated, a catheter is introduced over the guidewire, and the guidewire is subsequently removed. A contrast dye is injected through the catheter to obtain detailed images of the intracranial blood vessels, which aids in assessing the vascular anatomy and any abnormalities present. After the angiography is completed, the guidewire is reinserted, and the angiography catheter is removed. Following this, an infusion catheter is introduced over the guidewire to the targeted vascular territory. The pharmacologic agent is then delivered as a prolonged continuous infusion to effectively treat the vasospasm. If necessary, the catheter may be repositioned to access additional vascular territories, allowing for the subsequent delivery of pharmacologic agents before the catheter is removed at the end of the treatment period. This comprehensive procedure includes both the diagnostic angiography and the imaging guidance necessary for successful intervention.
Post-procedure care following the administration of pharmacologic agents via CPT® Code 61651 typically involves monitoring the patient for any immediate adverse reactions to the medication. Continuous observation of neurological status is essential to assess the effectiveness of the treatment and to identify any potential complications. Patients may also require follow-up imaging studies to evaluate the response to the pharmacologic agents and to ensure that the vasospasm has been adequately addressed. Additional considerations may include managing any discomfort or side effects associated with the procedure and providing instructions for follow-up care.
| Short Descr | EVASC PRLNG ADMN RX AGNT ADD | Medium Descr | EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL | Long Descr | 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) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 61650 | 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; initial vascular territory | 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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | 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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