How To Use CPT Code 61698

CPT 61698 describes the surgical treatment of a complex intracranial aneurysm using an intracranial approach in the vertebrobasilar circulation. 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 61698?

CPT 61698 can be used to describe the surgical treatment of a complex intracranial aneurysm using an intracranial approach in the vertebrobasilar circulation. This code is used when the provider repairs an abnormal dilation of a blood vessel in the internal vertebrobasilar circulation through a surgical procedure.

2. Official Description

The official description of CPT code 61698 is: ‘Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar circulation.’ This code is used for the treatment of complex intracranial aneurysms that are larger than 15 mm or have calcification of the aneurysm neck, incorporation of normal vessels into the aneurysm neck, or require temporary vessel occlusion, trapping, or cardiopulmonary bypass during the procedure.

3. Procedure

1. The provider begins by making an incision in the scalp over the area of the aneurysm.
2. Next, the provider uses a surgical drill to create burr holes in the skull and removes a bone flap to expose the dura, the protective layer covering the brain.
3. The provider then carefully dissects down to expose the aneurysm, identifying the neck of the aneurysm and any vessels that are part of it.
4. Depending on the complexity of the aneurysm, the provider may clip the neck of the aneurysm, incise and suture the aneurysm if it has a calcified wall structure, or bypass the aneurysm before occluding it if critical vessels arise from it.
5. After resolving the aneurysm, the provider ensures hemostasis and checks the trapping, resection, or bypass repair of the vessel.
6. Finally, the provider closes the dura, replaces and secures the bone flap, and closes the scalp.

4. Qualifying circumstances

CPT 61698 is used for the treatment of complex intracranial aneurysms that are larger than 15 mm or have calcification of the aneurysm neck, incorporation of normal vessels into the aneurysm neck, or require temporary vessel occlusion, trapping, or cardiopulmonary bypass during the procedure. The provider considers an aneurysm complex if it is difficult to access or has arterial trunks and branches that are part of the aneurysm.

5. When to use CPT code 61698

CPT code 61698 should be used when a provider performs surgery to treat a complex intracranial aneurysm using an intracranial approach in the vertebrobasilar circulation. This code should not be used for aneurysms in the carotid circulation, which are covered by a different code (61697).

6. Documentation requirements

To support a claim for CPT 61698, the provider must document the following information:

• Diagnosis of a complex intracranial aneurysm
• Details of the surgical procedure performed, including the approach used and any additional techniques or procedures
• Any qualifying circumstances, such as the size of the aneurysm or the need for temporary vessel occlusion, trapping, or cardiopulmonary bypass
• Documentation of hemostasis and the outcome of the procedure
• Signature of the provider performing the surgery

7. Billing guidelines

When billing for CPT 61698, ensure that the procedure meets the qualifying circumstances described in the official description. It is important to note that CPT 61698 should not be reported with other codes (61697, 61699) for the same aneurysm treatment. Additional tips for reporting CPT 61698 may include considering the location and complexity of the aneurysm, as well as any additional procedures or techniques performed during the surgery.

8. Historical information

CPT 61698 was added to the Current Procedural Terminology system on January 1, 2001. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs surgery to treat a complex intracranial aneurysm in the vertebrobasilar circulation using an intracranial approach.
2. A patient with a large intracranial aneurysm in the vertebrobasilar circulation undergoes surgery to repair the aneurysm.
3. A provider performs a complex intracranial aneurysm repair using an intracranial approach in the vertebrobasilar circulation, incorporating temporary vessel occlusion during the procedure.
4. A patient with a calcified complex intracranial aneurysm in the vertebrobasilar circulation undergoes surgery to treat the aneurysm.
5. A provider performs surgery to repair a complex intracranial aneurysm in the vertebrobasilar circulation, requiring cardiopulmonary bypass during the procedure.
6. A patient with an intracranial aneurysm in the vertebrobasilar circulation undergoes surgery to exclude the aneurysm from the cerebral circulation.