Analyzing Non-Thrombolytic Agent Administration

Interventional radiology coding can present significant challenges for coders and compliance professionals alike. One area that our experts identified as significantly complex and worthy of a targeted review for understanding is head and neck coding. Non-thrombolytic agent administration is one component of this area where coders can benefit from a look at the nuances for further success throughout 2023.

Breaking Down Coding Barriers  

So what codes are involved in this area? The following codes comprise analyzing non-thrombolytic agent administration:

Prolonged intracranial artery administration of pharmacologic agents for vasospasm or other nonthrombolytic indications is reported with codes 61650–61651. Understand that this procedure may have been previously reported with codes 37202, 75896, however those codes are now deleted.

Coders may have questions about how “prolonged” is defined. For these codes, “prolonged” means at least 10 minutes and may be continuous or intermittent administration. Coders must be cautious when it comes to the administration of certain substances. You may not report codes  61650–61651 for administration of the following:

• 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. Three cerebral artery territories relate to these codes:

• Right carotid circulation

• Left carotid circulation

• Vertebro-basilar circulation.

When non-thrombolytic medications are administered into cerebral arteries, report code 61650 for the first territory treated, and 61651 for administration into each additional cerebral territory (maximum of two times).

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. CPT® codes 36221–36228 may not be reported in addition to 61650, 61651 for the same vascular territory. Intracranial dilation for vasospasm (61640–61642) may not be coded with intracranial administration of pharmacologic agents (61650–61651) for the same vascular territory.

Documentation Hints

As the codes do not state “infusion” in their narrative description, infusion does not have to be documented. Instead, they state “prolonged administration.” CPT® directives state prolonged administration is 10 minutes of continuous or intermittent duration. Physician documentation will be key for validating the assignment of these codes.

Territories and Reporting with Additional Codes

As previously mentioned, there are specific procedures that cannot be coded in addition to code 61650 or 61651 for the territory treated:

• Diagnostic imaging of the arch (36221)
• Diagnostic imaging of the extracranial carotid artery (36222)
• Diagnostic imaging of the intracranial carotid artery and branches (36223-36224)
• Diagnostic imaging of the vertebral artery from either a subclavian or vertebral injection ( 36225 or 36226)
• Intracranial balloon inflation for vasospasm, initial vessel (61640)
• Intracranial balloon inflation for vasospasm, each additional vessel, same territory (61641)
• Intracranial balloon inflation for vasospasm, each additional vessel, different vascular territory (61642)
• Intracranial arterial mechanical thrombectomy (61645)

The following codes should not be assigned for the same vascular territory:

• 96420 Chemotherapy administration, intra-arterial; push technique
• 96422 Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour
• 96423 Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure)
• 96425 Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump

These are not all the essential coding tips and rationale for basic interventional radiology knowledge and head and neck coding. As service volumes rebound and every dollar of reimbursement counts more than ever, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics, and break down the complexity with our expert-infused 2023 Head and Neck Interventional Radiology Coding, live on  Wednesday, July 12, 2023. This webcast is an essential training tool for both audio and visual learners.