How To Use CPT Code 61645

CPT 61645 describes the 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). This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 61645?

CPT 61645 can be used to describe a specific procedure performed by a healthcare provider to remove a clot or dissolve it using mechanical devices and/or thrombolytic infusion in the intracranial arteries. This code includes diagnostic angiography, fluoroscopic guidance, catheter placement, and the administration of thrombolytic medication. The procedure is performed percutaneously, meaning through a small incision in the skin, and is used to restore blood flow in the affected intracranial artery.

2. Official Description

The official description of CPT code 61645 is: ‘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).’ It is important to note that this code should not be reported in conjunction with certain other codes for the same vascular territory.

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring they are appropriately prepped and anesthetized.
2. A small incision is made in the skin, and the provider identifies the site of the affected intracranial artery.
3. Vascular clamps are placed across the artery to control blood flow.
4. Diagnostic angiography is performed to confirm the location of the blocked arteries.
5. An arterial puncture is made to insert a catheter system into the blocked vessel.
6. A heparin-saline solution is injected through the access site.
7. A fiberoptic angioscope is used to visualize the arterial thrombosis.
8. Under fluoroscopic guidance, a guide wire is inserted into the artery, and the catheter is advanced to the site of occlusion.
9. A thrombolytic agent is injected to dissolve the clot, or a mechanical device is used to break the clot into smaller pieces.
10. Clot fragments are suctioned out from the affected artery to restore blood flow.
11. The catheter system is removed, and bleeding is controlled by applying pressure at the entry site.

4. Qualifying circumstances

CPT 61645 is performed on patients with intracranial arterial thrombosis that requires revascularization. It is used when there is a need to remove or dissolve a clot in the intracranial arteries. This procedure is typically performed by a healthcare provider who specializes in endovascular interventions and has the necessary expertise and equipment to perform the procedure safely and effectively.

5. When to use CPT code 61645

CPT code 61645 should be used when a healthcare provider performs percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis in the intracranial arteries. It is important to note that this code should not be reported with certain other codes for the same vascular territory. It is crucial to review the documentation and guidelines to ensure accurate reporting of the procedure.

6. Documentation requirements

To support a claim for CPT 61645, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Details of the procedure performed, including the specific techniques used
• Date and duration of the procedure
• Specific arteries treated
• Administration of thrombolytic medication, if applicable
• Any complications or adverse events
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 61645, it is important to ensure accurate reporting and adherence to billing guidelines. This includes not reporting the code in conjunction with certain other codes for the same vascular territory. It is recommended to review the specific guidelines and documentation requirements provided by the payer to ensure proper billing and reimbursement.

8. Historical information

CPT 61645 was added to the Current Procedural Terminology system on January 1, 2016. It has not undergone any updates since its addition. It is important to stay updated with any changes or revisions to the code in order to accurately report the procedure.

9. Examples

1. A healthcare provider performs percutaneous arterial transluminal mechanical thrombectomy to remove a clot in the right carotid circulation of a patient with intracranial arterial thrombosis.
2. Using fluoroscopic guidance, a healthcare provider performs thrombolysis in the left carotid circulation of a patient with a clot in the intracranial arteries.
3. A catheter is inserted percutaneously to perform mechanical thrombectomy and administer thrombolytic medication in the vertebro-basilar circulation of a patient with intracranial arterial thrombosis.
4. A healthcare provider performs diagnostic angiography, catheter placement, and thrombolysis in the right carotid circulation of a patient with a clot in the intracranial arteries.