Q & A with Dr. Z: Embolization of Middle Meningeal Artery

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

Question:
What is the correct code to bill for the embolization of middle meningeal artery (MMA)? Is it CPT code 61624 or 61626 since the MMA is part of the external carotid artery (ECA)? For this procedure, selective catheter placements and angiograms were done on the bilateral common carotid arteries (intracranial), bilateral ECAs and bilateral MMAs, along with the embolization. I am coding 36222-50, 36227-50, 75894, and 75898, just unsure whether to assign the 61626 or the 61624. Our coder says it should be 61624 but the provider thinks it should be 61626. Please advise.

Answer:
The pathology being treated is CNS (brain tumor called meningioma), so 61624 applies. If for subdural bleeding next to the brain (in the CNS) via the MMA, we would still report 61624. The brain is not the head and neck. If for nosebleed, glomus tumor, facial AMV, tongue tumor, etc of the head and neck, report 61626, however the MMA supplies the brain via a foramen in the skull.

Remember, it is not the vessel you are embolizing, but the pathology you are treating, when it comes to the embolization code, however the catheter placement is based on catheter tip location. We also see the spinal artery selected and embolized, but for a vertebral body tumor, which is NOT spinal/CNS, rather it is 37243 for treating the pathology of treating tumor of a bone. Your coder is absolutely correct to recommend 61624 IF the MMA embolization is for a CNS treatment.

 

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About the Author

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