How To Use CPT Code 61640

CPT 61640 describes the procedure of balloon dilatation of intracranial vasospasm, performed percutaneously by the provider. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61640?

CPT 61640 can be used to describe the procedure of balloon dilatation of intracranial vasospasm. This procedure involves the provider using a balloon placed percutaneously in the femoral artery to widen a vasospastic segment of an intracranial vessel. It is typically performed after an acute subarachnoid hemorrhage to alleviate the constriction or narrowing of the blood vessel.

2. Official Description

The official description of CPT code 61640 is: ‘Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel.’

3. Procedure

1. The provider begins by obtaining diagnostic angiograms to confirm the presence and location of the vasospasm.
2. Intravenous heparin is administered to the patient before and during the procedure to prevent blood clots.
3. The provider catheterizes the common femoral artery and performs another angiography to ensure no changes since the initial diagnostic angiograms.
4. A catheter is advanced over a guidewire through the intracranial vessels, and additional angiograms are obtained to confirm proper positioning of the catheter and targeted arterial stenosis.
5. The provider measures the stenotic artery to determine the appropriate diameter and length of the angioplasty balloon.
6. Using fluoroscopy for visualization, the provider slowly inflates the balloon to dilate the lesion, then deflates it and partially withdraws it, leaving the guidewire across the stenosis.
7. Contrast is injected through the guidewire to confirm dilatation of the vessel, and additional angiograms are taken to ensure there is no restenosis or arterial blockage.
8. After observing the patient for any further complications, the provider removes the balloon and guidewire and takes final angiograms to check for any complications.

4. Qualifying circumstances

Patients who have confirmed vasospasm and require balloon dilatation of intracranial vessels are eligible for CPT 61640. This procedure is typically performed after an acute subarachnoid hemorrhage. The provider must obtain diagnostic angiograms to confirm the presence and location of the vasospasm. Intravenous heparin is administered to prevent blood clots during the procedure. The procedure involves the percutaneous placement of a balloon in the femoral artery to dilate the vasospastic segment of the intracranial vessel.

5. When to use CPT code 61640

CPT code 61640 should be used when the provider performs the initial balloon dilatation of an intracranial vessel to treat vasospasm. It is important to note that this code is specific to the initial vessel. If additional vessels in the same vascular territory require balloon dilatation, CPT code 61641 should be used. If the procedure involves a different vascular territory, CPT code 61642 is appropriate.

6. Documentation requirements

To support a claim for CPT 61640, the provider must document the following information:

• Confirmation of the vasospasm through diagnostic angiograms
• Administration of intravenous heparin
• Details of the catheterization and angiography procedures
• Measurement of the stenotic artery and selection of the appropriate balloon size
• Fluoroscopy-guided balloon inflation and deflation
• Confirmation of dilatation through contrast injection and additional angiograms
• Observation period for any complications
• Removal of the balloon and guidewire
• Final angiograms to check for complications

7. Billing guidelines

When billing for CPT 61640, ensure that the procedure involves the initial vessel and is performed percutaneously. It is important to follow the specific guidelines for reporting additional vessels in the same vascular territory (CPT 61641) or different vascular territory (CPT 61642). Pay attention to the details in the operative report to determine the appropriate code based on the region of the brain being treated. If there is any ambiguity, consult with the provider for clarification.

8. Historical information

CPT 61640 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs balloon dilatation of an intracranial vasospasm in the initial vessel of a patient who experienced an acute subarachnoid hemorrhage.
2. During the procedure, the provider successfully dilates the vasospastic segment of the intracranial vessel using a percutaneously placed balloon.
3. Another patient requires balloon dilatation of an intracranial vasospasm in a different vascular territory, and the provider performs the procedure accordingly.
4. The provider obtains diagnostic angiograms to confirm the presence and location of the vasospasm in each case.
5. Intravenous heparin is administered to prevent blood clots during the procedures.
6. Both patients undergo fluoroscopy-guided balloon inflation and deflation, followed by confirmation of dilatation through contrast injection and additional angiograms.