What are the CPT (Current Procedural Terminology) codes for subdural hematoma embolization and brain aneurysm embolization?

CPT Codes for Subdural Hematoma and Brain Aneurysm Embolization

Subdural Hematoma Embolization

For subdural hematoma embolization, the appropriate CPT code is 61626 (Transcatheter permanent occlusion or embolization of non-central nervous system vessel). This code is used specifically for the embolization of the middle meningeal artery (MMA) in cases of chronic subdural hematoma.

Middle meningeal artery embolization has emerged as an effective treatment for chronic subdural hematomas, with recent evidence showing:

• A randomized controlled trial demonstrated that MMA embolization as an adjunct to standard treatment resulted in a significantly lower risk of treatment failure (16% vs 36%) compared to standard treatment alone 1
• A multi-center study of 154 consecutive embolizations showed 70.8% of patients had >50% improvement on imaging with only 6.5% requiring further treatment 2
• The procedure is typically performed using either particles (70.2%) or liquid embolic agents (25.3%) 2

Brain Aneurysm Embolization

For brain aneurysm embolization, the appropriate CPT code is 61624 (Transcatheter permanent occlusion or embolization of intracranial arterial or venous sinus; any method, including radiological supervision and interpretation).

This code specifically covers:

• Endovascular coil embolization of intracranial aneurysms
• Procedures using detachable platinum coils (such as Guglielmi detachable coils)
• Other endovascular techniques for treating brain aneurysms

Key Differences Between the Procedures

1. Anatomical location:

   • Subdural hematoma embolization targets the middle meningeal artery (non-CNS vessel)
   • Brain aneurysm embolization targets intracranial arteries (CNS vessels)

2. Clinical indications:

   • Subdural hematoma embolization is used for chronic subdural hematomas to prevent recurrence
   • Brain aneurysm embolization is used to prevent rupture or rebleeding of intracranial aneurysms

3. Technique:

   • Subdural hematoma embolization typically uses particles or liquid embolic agents to occlude the middle meningeal artery
   • Brain aneurysm embolization typically uses detachable coils to fill the aneurysm sac

Coding Considerations

When coding these procedures, it's important to note:

• Both procedures require appropriate diagnostic angiography codes in addition to the embolization codes
• If bilateral embolization is performed for subdural hematomas, modifier -50 may be appropriate
• Documentation should clearly specify the vessels treated and materials used
• For complex cases involving multiple vessels, additional codes may be required

The American Heart Association/American Stroke Association guidelines support endovascular coiling as a preferred treatment for many brain aneurysms when technically feasible 3.

For subdural hematomas, while traditional surgical evacuation remains the standard of care for acute cases 4, middle meningeal artery embolization is gaining acceptance for chronic subdural hematomas based on recent clinical evidence 1.