CPT® Code 61650

Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory

The procedure described by CPT® Code 61650 involves the endovascular intracranial prolonged administration of pharmacologic agents, specifically excluding thrombolysis. This procedure is primarily aimed at treating conditions such as arterial vasospasm that may occur following a stroke. The pharmacologic agents utilized in this context may include medications like papaverine, nicardipine, and verapamil, which are known for their effectiveness in alleviating vasospasm by relaxing the blood vessels. The access to the intracranial blood vessels is achieved through a peripheral artery, which allows for a minimally invasive approach to deliver the necessary treatment directly to the affected area. The procedure is guided by fluoroscopy, a real-time imaging technique that ensures accurate placement of instruments within the vascular system. The process begins with the introduction of a needle into the artery, followed by the advancement of a thin wire to the targeted vascular area. If diagnostic angiography is indicated, a catheter is placed over the guidewire to visualize the intracranial blood vessels using contrast dye. This imaging step is crucial for assessing the vascular anatomy and confirming the presence of vasospasm. After obtaining the necessary images, the guidewire is reinserted, and the angiography catheter is removed. Subsequently, an infusion catheter is introduced to deliver the pharmacologic agent as a prolonged continuous infusion to the targeted vascular territory. This procedure may also allow for the movement of the catheter to access additional vascular territories, facilitating the delivery of pharmacologic agents as needed. Overall, this code encompasses the entire process, including diagnostic angiography and imaging guidance, ensuring comprehensive treatment for patients experiencing arterial vasospasm.