Q: For an intracranial embolization procedure using a stent (pipeline or flow diverter) only—without any coils whatsoever—by placing the stent across the neck of the aneurysm, do we code for the stenting (61635) or for the embolization (61624)?
A: The nomenclature used for these devices is critical when discussing the associated coding. Flow-diverting devices (e.g., Pipeline Embolization Device [PED], Surpass, Flow Re-direction Endoluminal Device [FRED]) are FDA-approved as a “new class of embolization devices.” For the procedure described in this question, when using a device that is labeled as a “flow diverter” the correct coding would be to report CPT 61624—Transcatheter permanent 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).
Additionally, the following radiologic supervision and interpretation (RS&I) codes may also be reported:
- 75894—Transcatheter therapy, embolization, any method, radiological supervision and interpretation
- 75898—Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis
Documentation should be clear as to what type of device is used, noting that a flow diverter is different than a stent.
Q: Can the CPT code 61635 (intracranial stent) be used for the cerebral venous circulation as well? The CPT descriptor does not describe a specific vascular bed.
A: The guidelines located on p. 455 of the 2021 AMA CPT® Professional Edition book provide detailed instructions for CPT codes 61630, 61635, 61640–61642 (intracranial angioplasty and stenting). This language specifically references arteries and their associated arterial territories, defined as the right carotid circulation, left carotid circulation and vertebrobasilar circulation. While the stated CPT descriptors are not specific to which vasculature, the intent, as evidenced by the supporting introductory language in CPT, is that these codes are to be used specifically for the arterial vasculature and are not recommended for use in the venous system.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2021/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2021 CPT® for full and complete guidelines.
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