# celiac stent placement



## prabha (Aug 19, 2009)

Can we code the below procedure with 

37205
36245
75960-26
75726-26
75625-26   

       Procedure.  Aortogram.  Celiac arteriogram.  Celiac angioplasty
      and stent placement.      
      Procedure.      
      Informed consent was obtained.  The patient was prepped and draped
      appropriately and after infiltration with local anesthesia the
      left axillary artery was punctured with a micropuncture set and a
      long 6-French sheath introduced.  Through this an Omniflush
      catheter  was manipulated into the descending aorta and the sheath
      further advanced.  The Omni flush catheter was then positioned 
      just above the celiac axis and contrast injected with filming in
      the lateral projection.

         Findings.      
      Aortogram.      
      The aortogram shows two superior mesenteric artery stents which do
      not overlap.  The trailing end of the proximal stent is not in the
      true aortic lumen.  There is extensive calcification in the region
      of the celiac axis and extending to 1 cm above it.  There is a
      large saucerized plaque across the origin of the celiac artery.
      The celiac artery is not seen but some contrast does fill to the
      celiac branches.  No contrast enters the superior mesenteric
      artery.  The stents extend over a distance of 5 cm.

      Celiac arteriogram.      
      The  hepatic and splenic arteries fill but there is a 95% stenosis
      in the right hepatic artery.  The gastroduodenal is enlarged but
      is not in continuity with the inferior pancreaticoduodenal artery.
      The distal branch of the gastroduodenal artery fills some of the
      duodenum and there is reconstitution of the ileocolic artery and
      several mesenteric vessels.  The amount of filling is poor.  There
      has been a previous bowel resection.  Also filling is an isolated
      middle colic artery which fills the left colic down to about the
      sigmoid.  The inferior mesenteric artery does not reconstitute.

       Procedure.      
       The Omni flush catheter was exchanged for a Berenstein catheter
      and a stiff Terumo wire  used to probe the superior mesenteric
      artery but this vessel could not be entered.  The catheter was 
      then pulled back and the celiac artery entered followed by the
      Berenstein catheter.  An exchange is made over a Rosen wire for a
      7 mm Palmaz Genesis stent 29 mm in length which was positioned
      across the ostial stenosis with its trailing end into the aorta.
      A slight waist where the stent passed through the aortic wall
      calcium could not be completely eliminated but a 6-mm diameter was
      achieved.  A celiac arteriogram was performed before the stent was
      placed.

      Contrast injection after the procedure demonstrated good flow
      through the celiac trunk via the stent.  The celiac pressure which
      previously had been 23 mm systolic now equalized with the aortic
      pressure to demonstrate that the 110mm gradient had been removed.

      Impression.      
        Status post SMA stent placement with occlusion of the superior
      mesenteric artery.  The mesenteric circulation is extensively
      compromised with no inferior pancreaticoduodenal and no connection
      save for via collaterals with the middle and left colic artery.
      The IMA does not fill.
      7 mm stent placement in a subtotal occlusion of the celiac trunk.


----------



## mikereyland (Aug 19, 2009)

That is correct though the visceral angiogram will need a 59 modifier due to the stent placement 75726-26-59.


----------



## dpeoples (Aug 19, 2009)

prabha said:


> Can we code the below procedure with
> 
> 37205
> 36245
> ...



_The Omni flush catheter was then positioned 
      just above the celiac axis and contrast injected with filming in
      the lateral projection._
This implies that the celiac was not selected for the initial visceral angiography therefor this is an abdominal aortogram only. _A celiac arteriogram was performed before the stent was placed._ There is no interpretation for this procedure.

The post stent images are for follow up only and should not be considered a diagnostic visceral angiography IMO.

Under the impression the physician states the stent was placed in the SMA but the procedural documentation is for the celiac. This does not change the code but needs to be clairfied for document integrity.

So, I would code 
37205/75960 (26)
36245
75625 (26)

HTH


----------



## mikereyland (Aug 19, 2009)

The Interpretation is before the procedure under the heading Celiac Arteriogram.


----------



## dpeoples (Aug 19, 2009)

mikereyland said:


> The Interpretation is before the procedure under the heading Celiac Arteriogram.



The celiac had not yet been selected. The code 75726 requires selection of the artery.


----------



## Partha (Aug 19, 2009)

dpeoples said:


> The celiac had not yet been selected. The code 75726 requires selection of the artery.



I concur with not using 75726


----------

