Neurosurgery Coding Alert

Question: I have a question regarding percutaneous balloon dilatation of intracranial vasospasms. One of the add-on codes specifies “each additional vessel in different vascular territory.” What are the different vascular areas, for coding purposes?

AAPC Forum Subscriber

Answer: The codes you’re dealing with here are:

• 61640 (Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel)
• +61641 (… each additional vessel in same vascular territory (List separately in addition to code for primary procedure))
• +61642 (… each additional vessel in different vascular territory (List separately in addition to code for primary procedure))

The language you’re referring to resides in +61642. The different vascular territories in the brain are primarily supplied by three major arteries: the anterior cerebral artery (ACA), the middle cerebral artery (MCA), and the posterior cerebral artery (PCA). These territories can be further divided as follows:

Anterior Cerebral Artery (ACA) territory:

• Medial and superior parts of the frontal and parietal lobes
• Corpus callosum
• Anterior limb of the internal capsule

Middle Cerebral Artery (MCA) territory:

• Lateral parts of the frontal, parietal, and temporal lobes
• Insula
• Basal ganglia
• Most of the internal capsule

Posterior Cerebral Artery (PCA) territory:

• Occipital lobe
• Inferior and medial parts of the temporal lobe
• Thalamus
• Midbrain.