Help! Attempted neuro-embolization....

s_harris14

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Patient was brought in for planned Balloon Test Occlusion & Possible Embolization of a meningioma prior to surgical resection. I've condensed the note to only highlight the procedural work:

Diagnostic catheter was navigated into the L ICA and an angiogram obtained.

Next, microcatheter was prepared, advanced under fluoroscopic guidance and roadmapping techniques with placement into the orifice of the vascular supply of the tumor. A super-selective angiogram was obtained.

An angiogram was then obtained via the guide catheter. Multiple attempts to advance a microcatheter were unsuccessful.

At this time the patient was noted for mild vasospam in the left internal carotid artery, which was successfully treated with 10mg of intra-arterial Verapamil.

Emergent angiograms reveal no evidence of thromboembolic disease and unchanged appearance of the tumor blush.

How would you code this? I thought only the intra-arterial Verapamil infusion (61650) would be coded, but my provider believes the attempted embolization (61624, 75894) can be billed because the microcatheter was in position.

Thanks in advance!
Stephanie
 

Jim Pawloski

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Patient was brought in for planned Balloon Test Occlusion & Possible Embolization of a meningioma prior to surgical resection. I've condensed the note to only highlight the procedural work:

Diagnostic catheter was navigated into the L ICA and an angiogram obtained.

Next, microcatheter was prepared, advanced under fluoroscopic guidance and roadmapping techniques with placement into the orifice of the vascular supply of the tumor. A super-selective angiogram was obtained.

An angiogram was then obtained via the guide catheter. Multiple attempts to advance a microcatheter were unsuccessful.

At this time the patient was noted for mild vasospam in the left internal carotid artery, which was successfully treated with 10mg of intra-arterial Verapamil.

Emergent angiograms reveal no evidence of thromboembolic disease and unchanged appearance of the tumor blush.

How would you code this? I thought only the intra-arterial Verapamil infusion (61650) would be coded, but my provider believes the attempted embolization (61624, 75894) can be billed because the microcatheter was in position.

Thanks in advance!
Stephanie

Hi Stephanie,
I would bill for the Verapamil infusion as well as 36224 for the Left Internal Carotid, and 36228 for the superselective cerebral. I would not bill for embolization unless it took a long time for the attempt, then I would use a modifier-74 (assuming you are billing for the hospital).
HTH,
Jim Pawloski, CIRCC
 
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