Question Cerebral Angiogram, Attempted Mechanical Thrombectomy

Joyce Burchett

Mount Auburn, IL
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Have a neuro surgeon that does cerebral angiograms. Need help coding this procedure. Patient with known intracranial stenosis presented with right facial droop, hemiparesis & aphasia. A CT, CTA, & CT perfusion showed narrowing of the Left M2 with corresponding decreased cerebral blood flow & preserved penumbra. Discussed with family & recommended attempt at mechanical thrombectomy. Right common femoral artery accessed with micropuncture kit & a control common femoral artery angiogram obtained to evaluate for dissection or injury. A 9-French sheath placed & an arterial line was attached to it for anesthesia monitoring & secured. A 088 Neuron Max catheter was advanced over a 6-French SIM@ catheter into the aortic arch, & the left common carotid artery was selected. Under roadmap conditions, the 088 guide was advanced over the diagnostic catheter into the left ICA. A stable cath position established in the left ICA. AP & lateral cervical & cerebral angiograms obtained. There was a severely narrowed M2 segment. Under roadmap conditions, this segment was accessed with a microwire & a Marksman. After advancing the microcatheter into the M2 segment super-selective injections were obtained. The catheter was removed, & another run was obtained to show the M2 segment open & wider with stenting. I attempted to inject TPA, but given the risks, I decided not to. After establishing antegrade flow in that segment, control runs were obtained. Catheter & sheaths were removed & hemostasis achieved in right groin with angio-seal.
Originally coded the procedure as 36223 & 75898, but am wondering if should have used 61645 instead? We are new to coding cerebral angiograms & are teaching ourselves. Any help would be appreciated.