2025 CPT code 61645
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Nervous System - Endovascular Therapy Procedures on the Skull, Meninges, and Brain Surgery Feed
Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography.
Modifiers may be applied based on the specific circumstances of the procedure (e.g., 59 for distinct procedural service, 76 for repeat procedure, 22 for increased procedural services, 50 for bilateral procedure, etc.).
Medical necessity is established by the presence of an acute ischemic stroke confirmed by neuroimaging, demonstrating a large vessel occlusion amenable to mechanical thrombectomy or thrombolysis.The procedure must be performed within the established time window for optimal benefit.
The clinical responsibility involves pre-procedural preparation, including patient assessment and informed consent. The neurointerventionalist performs the procedure under fluoroscopic guidance, managing catheter placement, mechanical thrombectomy or thrombolytic infusion, and diagnostic angiography.Post-procedural care includes monitoring for complications and ensuring appropriate recovery.
- Surgery
- Surgical Procedures on the Nervous System > Surgical Procedures on the Skull, Meninges, and Brain > Endovascular Therapy Procedures on the Skull, Meninges, and Brain > Cerebral Endovascular Therapeutic Interventions
In simple words: This procedure uses a thin tube (catheter) inserted into a blocked artery in the brain to remove a blood clot.It might involve dissolving the clot with medication or physically removing it with a special device.X-rays are used to guide the process, and the doctor monitors the patient's brain activity and blood flow throughout. This process is done to restore blood flow to the brain.
This CPT code, 61645, encompasses percutaneous arterial transluminal mechanical thrombectomy and/or thrombolytic infusion for intracranial arterial thrombi.The procedure involves catheter placement, injection of thrombolytic medication (clot-busting drugs) or mechanical thrombectomy (physical removal of the clot), and diagnostic angiography (contrast-enhanced imaging of blood vessels) under fluoroscopic guidance. It includes all associated radiological supervision and interpretation within the treated vascular territory, neurologic and hemodynamic monitoring, and arteriotomy closure.The intracranial arteries are categorized into three vascular territories: right carotid circulation, left carotid circulation, and vertebrobasilar circulation.The code can be reported once for each territory treated.Prolonged administration of non-thrombolytic agents (e.g., spasmolytics or chemotherapy) is coded separately using 61650 and 61651.
Example 1: A 70-year-old patient presents with acute ischemic stroke secondary to a large thrombus in the right middle cerebral artery (MCA). The neurointerventionalist performs a mechanical thrombectomy using a stent retriever via the right common carotid artery.61645 is coded for the right carotid vascular territory., A 65-year-old patient experiences a stroke caused by a clot in the left internal carotid artery. The neurointerventionalist performs a thrombolysis via catheterization of the left common carotid artery. 61645 is reported for the left carotid territory., A 55-year-old patient presents with basilar artery occlusion.The neurointerventionalist accesses the vertebral artery and performs mechanical thrombectomy. 61645 is billed for the vertebrobasilar territory. If prolonged administration of a non-thrombolytic agent is necessary, 61650 or 61651 would also be used.
Detailed history and physical examination, including neurological assessment.Imaging studies (e.g., CT angiogram, MRI) demonstrating the occlusion.Documentation of the procedure, including the approach, type of thrombectomy/thrombolysis used, vascular territory treated, and fluoroscopic images.Post-procedure neurological assessment and any complications.
** Careful attention should be paid to the vascular territory treated to ensure accurate coding.The use of 61650 and 61651 should be considered if prolonged administration of non-thrombolytic agents is necessary.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: This information is not available in the provided sources.Refer to the CMS Physician Fee Schedule or a similar resource for current RVU values.
- Global Days: Information on global surgical days is not available in the provided sources and varies based on payer and location. Consult payer guidelines.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier is not applicable to this code as it represents a complete procedure.
- Fee Schedule: This information is not available in the provided sources. Fee schedules vary by payer and location.Refer to payer-specific fee schedules.
- Specialties:Neurology, Neurosurgery, Neuroradiology, Vascular Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center