Q & A with Dr. Z: Cerebral Aneurysm Embolization with Vasospasm

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Patient is status post pipeline embolization. Patient clinically, CTA (CT Angiography) and TCD’s (Transcranial Doppler) are consistent with vasospasm. Right vertebral angiogram showed vasospasm. Vasospasm was treated with 10mg of intra-arterial verapamil over a 10 minute infusion. Left internal carotid angiogram showed vasospasm and filling of the left ophthalmic aneurysm. The vasopasm was treated with 10 mg of intra-arterial verapamil over a ten minute infusion. Given persistent filling of the aneurysm, an additional Pipeline embolization was performed. A 4 x 12 pipeline was successfully deployed. Two follow up angiograms of the left internal carotid were performed.

Can we charge for follow up angiograms with a modifier for the embolization? Follow ups are bundled with 61650 and 61651.

Yes, each follow-up angiography related to the CNS embolization procedure (61624) is reported with 75898. Add the -59 modifier to let the payer know that this imaging is unrelated to the vasospasm treatment which was done prior to the embolization.


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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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