# Coding arterial catherizations



## drobinson1 (Aug 10, 2011)

*Good afternoon,

Just looking for an opinion on how to code this report.  I came up with 
37204/75894, 36247/75625,75726,75774 and 36245/75726. 
I know alot of them need modifiers. I'm just hoping I'm starting to get catherizations. This stuff is hard. lol!!!*

Reason For Study: GI Bleed
History: 81-year-old female with bleeding ulcer at the second portion of duodenum. This was clipped endoscopically but with incomplete control.

Prior to angiogram procedure, the patient was hydrated with normal saline solution at 120 cc per hour. A Foley catheter was placed.

Valium and Dilaudid was administered for patient pain and anxiety during the procedure.

Via the right common femoral artery, a 6 French sheath was placed. Through this, a 5 French Omni Flush catheter was advanced into the abdominal aorta. Left lateral abdominal aortogram was performed. The origin of the celiac axis appears to be mildly narrowed. The origin of the SMA appears moderately narrowed.

The catheter was exchanged for a SOS selective catheter. The celiac axis was selectively catheterized and celiac angiogram shows the celiac trunk supplying the common hepatic artery, the splenic artery and the left gastric artery. The left and right hepatic arteries divide early. The catheter was exchanged for a Cobra 2 catheter. With a Bentson guidewire, the celiac axis was again catheterized. Subsequently, the left hepatic artery was selectively catheterized. The gastroduodenal artery is the primary inferior branch. Arising from the gastroduodenal artery, the pancreaticoduodenal and the gastroepiploic artery are demonstrated but are not abnormally enlarged. A surgical clip in the duodenum is seen in close proximity to the distal gastroduodenal artery. However, the clip appears to be slightly mobile.

A Progreat microcatheter was coaxially placed through the Cobra catheter and with a 90 degrees angled micro-Glidewire the gastroduodenal artery was selectively catheterized. Selective gastroduodenal arteriogram was performed in different angulations. This demonstrates no evidence of extravasation. However, there is an area of irregular enhancement seen on sequence #10 and #11 lateral to the gastroduodenal artery. Therefore 2 gelfoam pledgets were injected through the Progreat microcatheter. A 3 mm x 3 cm platinum microcoil was additionally deployed. This resulted in occlusion of the distal gastroduodenal artery and nonenhancement of the the site of prior irregular enhancement. There was no evidence of nontarget embolization. The microcatheter was withdrawn. Contrast injection in the Cobra catheter showed no abnormal enhancement at the expected site of duodenal ulceration.

The catheter was withdrawn into the aorta and exchanged for a SOS selective catheter. The SMA was selectively catheterized. Brisk hand injection SMA angiogram shows normal appearance of the SMA, right colic and middle colic branches. There is no abnormal enhancement from the SMA angiogram. The inferior pancreaticoduodenal artery was visualized demonstrating no evidence of abnormal enhancement.

At the end of the procedure, the catheter was withdrawn through the sheath. The sheath was removed and hemostasis was achieved with hand compression using Syvek sea for a 20 minute compression time. Gauze and Tegaderm covered the access site. A compression bandage and 5 pounds sandbag covered the access sites.

Impression:
1. Gastroduodenal artery arises as a branch of the left hepatic artery. The left hepatic and right hepatic artery branch early from the common hepatic.
2. The gastroduodenal artery supplies an irregular focus of enhancement lateral to the gastroepiploic artery.
3. The gastroduodenal artery was embolized with 2 gelfoam pledgets and a 3 mm x 3 cm platinum microcoil. After embolization, there was complete absence of further abnormal enhancement of the site.
4. After GDA embolization, the inferior pancreaticoduodenal artery from SMA angiogram does not opacify the abnormal enhancing site.


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## vsmith (Aug 10, 2011)

EMAIL ME and I will help you will this one. The anathony of the aorta is confusing you and I will be glad to go over this with you.


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## Cassie0930 (Aug 17, 2011)

I would suggest:

75726-26    Celiac Arteriogram
36247-       Cath in Gastroduodenal
75774-26    Addtnl visceral arteriogram
37204-        Embolization
75894-26     S/I
75898-26     F/U
36245- 59    Cath in SMA
75726-26     SMA Arteriogram

Here is a guideline from Dr Z:
Do not code the non-selective aortogram (75625) when performed in conjunction with a selective visceral angiogram (75726)

Good Luck, hope this helped


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