Analyzing Non-Thrombolytic Agent Administration Coding

Interventional radiology has long been filled with complex procedures with non- thrombolytic agent administration being one area of challenge. Reviewing the fundamentals of  61650–61651 are important for successful CPT® coding. By gaining better comprehension of these services, healthcare coding and billing professionals can help ensure accurate coding while safeguarding full reimbursement.  Let’s take a look at some of the details that define these codes when it comes to interventional radiology coding and billing. 

Codes 61650–61651 detail the procedures of prolonged intracranial artery administration of pharmacologic agents for vasospasm or other nonthrombolytic indications. In the past, the service was previously reported using codes 37202 and 75896, however, those codes are now deleted. The code descriptions reference “prolonged.” What does this mean in terms of reporting? “Prolonged” in this case indicates at least 10 minutes and may be continuous or intermittent administration. Understand that you should not report 61650–61651 for the administration of heparin, nitroglycerine, saline, or other agents normally administered during an endovascular procedure. Note that cerebral endovascular therapeutic intervention codes 61645, 61650, and 61651 are coded once per territory.

61650Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory
+61651Endovascular 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)

Three cerebral artery territories relate to these codes:

  • Right carotid circulation
  • Left carotid circulation
  • Vertebro-basilar circulation.

In terms of administering non-thrombolytic medications into cerebral arteries, report code 61650 for the first territory treated, and 61651 for administration into each additional cerebral territory (maximum of two times). Know that codes 61650 and 61651 are complete codes and include vascular catheterization, diagnostic angiography, imaging supervision and interpretation, follow-up imaging, fluoroscopic guidance, neurologic and hemodynamic monitoring of the patient, and closure of the arteriotomy.

 It is imperative to know that CPT codes 36221– 36228 may not be reported in addition to 61650, 61651 for the same vascular territory. Also, recognize that intracranial dilation for vasospasm (61640–61642) may not be coded with intracranial administration of pharmacologic agents (61650–61651) for the same vascular territory.

Q. How many times may these codes be submitted.  What if a lesion is treated in the right and left carotid circulation?

A. Assign code 61650 for the initial territory treated. Assign code 61651 for the additional territory treated. Note that you must assign code 61650 before also assigning code 61651. Code 61651 may not be reported more than twice per day.

Q. May code 61645 be assigned in the same vascular territory as codes 61650 and 61651?

A. No, these codes should not be billed together for the same vascular territory. Code assignment should be based upon the primary need for therapy. As such, you should verify with your provider what their primary intent was when performing treatment.

Q. May these codes be used for thrombolytic therapy into an intracranial artery?

A. No, codes 61650 and 61651 are not to be used to report intracranial arterial thrombolytic infusion therapy.  Additionally, do not report these codes for the administration of saline, heparin, or nitroglycerin.

As the pandemic eases and service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and breakdown the complexity with expert-infused insight. Our upcoming Head and Neck Interventional Radiology Coding webcast on July 14 led by leading expert Jeff Majchrzak, BA, RCC, CIRCC, is an essential training tool for both audio and visual learners.