E991

PDF page 754 / X2

NEUROLOGICAL SURGICAL PROCEDURES
CRANIAL
                                                                                                   Asst         Surg         Anae
# E908         - removal of intracerebral and/or subdural haematoma in
                 conjunction with a ruptured intracranial aneurysm or
                 arteriovenous malformation, to N106 or N155 ........... add                                    304.30
# N218 Extracranial-intracranial microvascular anastomosis superficial
         temporal artery ...................................................................         15        1364.05         15
# N156 Occipital artery........................................................................      15        1229.55         15
# E904   - posterior fossa ........................................................... add                      241.00
# N121 Extracranial-intracranial long venous bypass (from internal
         carotid in the neck or any of the trunk vessels in the neck or
         chest to a major intracerebral vessel, i.e. vertebral, internal
         carotid, middle cerebral).....................................................              15        1711.40         15
    Carotid-cavernous fistula
# N108 Obliteration of intracranial dural arteriovenous fistula (including
          carotid cavernous fistula) to include craniotomy and
          combined cervical and intracranial procedure ....................                          15        1229.55         15
    INTRACRANIAL ENDOVASCULAR SURGERY
    Intracranial aneurysm repair
      Endovascular approaches
# N122 Anterior circulation ..................................................................       15 2302.30 20
# N125 Posterior circulation, including vein of Galen..........................                      15 2302.30 20
# E894     - aneurysm greater than 2.5 cm, to N122 or N125....... add                                    229.55
# E989     - balloon assistance or balloon standby, to N122 or N125
             ................................................................................... add     300.00
# E990     - stent assistance, to N122 or N125............................. add                          400.00
# E991     - flow-diverter or intra-saccular device deployment, to N122
             or N125 ...................................................................... add          700.00
      Payment rules:
      1.N122 and N125 are comprehensive intracranial endovascular management services
        including endovascular treatment of all intracranial aneurysm pathology in the anatomic area
        described.
         2.N122 and N125 include catheter placement, angiography and any image guidance.
           Obtaining and interpreting any images in conjunction with N122 and N125 are not eligible for
           payment to any physician.
         3.No ‘N’-prefix services other than N122 and N125 are eligible for payment during the same
           operative session.
         4.E989, E990, and E991 are payable once per eligible fee code per operative session. These
           fee codes are not payable per vessel or per device (even if multiple devices are used in the
           same category)
         5.E991 is not eligible for payment for liquid embolic agents, coil embolization or stent-assisted
           coiling
         [Commentary:
         1.“Intra-saccular devices” refer to endovascular implants designed to be deployed within the
           aneurysm sac to achieve in-saccular flow disruption or occlusion (e.g., WEB, Artisse).

Master, record 1676. Record Layout PDF, page 1.

E99120260401999999990000700000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.