Radiology Coding Alert

Coders who lack a thorough understanding of the heads vascular structures and the various components of cerebral embolizations run the risk of undercoding or incorrectly coding the procedure. This could result in practices not receiving the appropriate reimbursement or the increased risk of fraud and abuse investigations.

Lisa Grimes, RT [R], coding specialist for radiology administration at the University of Texas Houston-Health Science Center, offers two strategies to enhance general understanding of the procedure, as well as an explanation of the three specific components of embolization to help codersnovices and veterans alikeassign the most accurate codes and receive appropriate levels of reimbursement.

Components of a Cerebral Embolization

In addition to understanding the anatomy involved, Grimes notes that coders should recognize that there are three discreet components to a cerebral embolization: the embolization itself, catheterization and angiography. Each exhibits its own set of coding parameters, which must be taken into account to ensure the radiologist receives reimbursement commensurate with the tasks performed.

1. Choosing the Correct Cerebral Embolization. There are two major distinctions in cerebral embolization codes, which relate directly to the anatomical structure of cranial vessels:

A. Code CPT 61624 is assigned for embolizations of intracranial vessels (transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method; central nervous system [intracranial, spinal cord]).

B. Code CPT 61626 is assigned for embolizations of extracranial vessels (non-central nervous system, head or neck [extracranial, brachiocephalic branch]).

It is vital that coders recognize this basic distinction, Grimes says. As a general rule, extracranial vessels are those that feed the facein other words, those vessels in the head and neck not considered part of the central nervous system. Conversely, intracranial vessels specifically support the central nervous system, including the brain and the spinal cord.

Intracranial embolization procedures (61624) are most often performed on patients who suffer from conditions such as aneurysms (437.3) and arteriovenous malformations (AVM). Patients for whom extracranial embolization (61626) is most often performed may suffer from vascular tumors, epistaxis (784.7severe nosebleeds) or severe trauma like a gunshot or stab wound.

The radiological supervision and interpretation code that accompanies either embolization code is 75894 (transcatheter therapy, embolization, any method, radiological supervision and interpretation).

According to the Society of Cardiovascular and Interventional Radiologys (SCVIRs) Interventional Radiology Coding Users Guide, cerebral embolization procedures should be billed only one time per operative area, no matter how many vessels are actually embolized. Lets say that a patient has multiple blood vessels, or feeders, supplying an AVM that is embolized. Even though more than one embolization may be performed in different sections of the brain, it can be billed only once (61624). The head is considered a single [...]