October 2017 Q & A

Question: Can you bill 61635 and 61624 for the stent assisted coiling?

Diagnostic cerebral angiogram and stent-assisted coiling. Subsequently the stent was placed and unsheathed through the supraclinoid and ophthalmic segment of the ICA. DSA in AP and lateral views demonstrated optimal wall apposition. At that time the coil was introduced completely into the aneurysmal dome. Under new roadmapping a 5 x 15 hydroframe coil was introduced into the dome.

 Answer:

No. The “stent” is more of a lattice work to prevent coil migration. We just code the 61624, 75894, the imaging (or catheter placement if imaging was for guidance, measuring, etc) and 75898 for follow up imaging here. Adding 61635 at the same session would be “double billing” for the procedure. We only code for belt OR suspenders, not both (as the aneurysm coils and stent placement are both treating the same pathology, not separate pathologies as seen with non-target vessel embolization procedures such as an EVAR endograft placement over a non-target coil embolization of the IMA where both procedures could be billed). Also, 61635 is indicated for treatment of intracranial stenoses, and there is no stenosis.