# Sma/branch sma angiography



## margaret fahy (Feb 10, 2014)

Hey Guys,
Can you please comment on the correct angiography codes for the angiography of SMA and then superselective angiography of distal branch of SMA?
I get confused when the angiogs are in the same vascular family.
Would it be:  36247, 36245-59, 75726, 75774?  Or is it 36245, 75726, 75774?  Or 36247, 75726, 75774?
I have the rest of the codes....37204/75894..no post embo angio documented....
CLINICAL HISTORY: 27-month-old male with small bowel vascular
malformation and secondary episodes of severe anemia.

COMPARISON: CTA of the abdomen dated 12/10/2012.


PROCEDURE TIME: 2 hours

WEIGHT: 12.6 Kg

PROCEDURE: The skin of the right groin was prepped and draped in
sterile fashion.  Using ultrasound guidance a 21 gauge needle was
inserted in the right common femoral artery.  Once arterial blood
return was obtained a .018" Nitrex wire was placed into the artery
and advanced to the distal abdominal aorta.  The needle was
removed and replaced with a micropuncture sheath/dilator set.  The
wire was sized up to a .035" Newton wire, and a 4 French vascular
sheath was placed into the artery.  Via the arterial sheath a 4
French RIM catheter was advanced into the mid abdominal aorta and
digital subtraction angiography was performed.  This catheter was
manipulated until it was in the superior mesenteric artery and
selective biplane DSA was performed in the frontal projection
within the superior mesenteric artery.  A 2.4F Low Flow Renegade
catheter and 0.016 Fathom 16 guidewire were then inserted
coaxially through the 4 French RIM catheter and advanced into a
distal branch of the superior mesenteric artery.  Superselective
angiogram was repeated in the frontal projection following the
administration of 1 mg of glucagon in an effort to minimize
artifact from bowel peristalsis.  15 mg of papaverine were also
selectively administered via the catheter to induce venous
splanchnic vasodilation and improved splanchnic venous flow.  
Dynamic CT of the abdomen was also performed following manual
injection of 3 mL of Omnipaque 300 via the Low Flow Renegade
catheter.  

At the completion of diagnostic angiography, superselective distal
embolization of a distal branch of the superior mesenteric artery
was performed using a 0.018" straight coil (1.5 cm).

The catheter and sheath were then removed and manual compression
was applied until hemostasis was achieved.  A sterile occlusive
dressing was applied at the site.  There were no complications and
the patient left the IR Suite in stable condition.  Dr. was
present for the entire procedure.

FINDINGS:  

ABDOMINAL AORTOGRAM: The abdominal aorta demonstrates a normal
caliber and configuration.  The origins of the celiac and superior
mesenteric arteries appear to overlap slightly, but each possess a
separate origin.

SUPERIOR MESENTERIC ARTERY ANGIOGRAM:  The superior mesenteric
artery is normal in caliber and configuration.  No early draining
vein suggestive of an underlying arteriovenous malformation was
identified.  There was however, relative marked hyperenhancement
of a loop of bowel within the left inferior abdominal quadrant
during the delayed portovenous phase.  This area of relative
hyperenhancement corresponds to the location of the loops of
abnormally enhancing bowel identified on the CTA dated 12/10/2012.


SMA BRANCH ANGIOGRAM:  Superselective angiogram of a third order
branch within the distal superior mesenteric artery demonstrated
relative marked hyperenhancement of a loop of bowel within the
left inferior abdominal quadrant.  Several small dysplastic veins
could be appreciated during the delayed portal venous phase.   
Dynamic C-arm CT of the abdomen performed following manual
injection of 3 mL of Omnipaque 300 demonstrated an enhancing loop
of bowel within a similar location as the abnormally enhancing
loops of bowel identified on the CTA dated 12/10/2012. Three plane
reconstruction was performed at a separate workstation to confirm
the location of the abnormal bowel loop and correlation with the
prior CT.

SELECTIVE SMA BRANCH EMBOLIZATION: Ileal branch of the superior
mesenteric artery was superselectively catheterized and a single
straight coil was successfully inserted for localization
intra-operatively.   

Permanent C-arm CT, ultrasound, and fluoroscopic images were
obtained and stored in the PACS system.

IMPRESSION


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## dpeoples (Feb 10, 2014)

margaret fahy said:


> Hey Guys,
> Can you please comment on the correct angiography codes for the angiography of SMA and then superselective angiography of distal branch of SMA?
> I get confused when the angiogs are in the same vascular family.
> Would it be:  36247, 36245-59, 75726, 75774?  Or is it 36245, 75726, 75774?  Or 36247, 75726, 75774?
> ...



I suggest 37242,36247 only.

HTH


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## margaret fahy (Feb 10, 2014)

*Danny-forgot to mention....*

Danny,
So sorry...forgot to mention this is for a charge correction.
This service was done in 2013.
Can you comment on the proper coding of this in 2013?
Duh...can't believe I forgot that part.
Margie


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## Jim Pawloski (Feb 10, 2014)

margaret fahy said:


> Danny,
> So sorry...forgot to mention this is for a charge correction.
> This service was done in 2013.
> Can you comment on the proper coding of this in 2013?
> ...



I have 36247, 75726, 75774, 76377, 37204, 75894, 75898 for 2013 coding

HTH,
Jim Pawloski, CIRCC


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## dpeoples (Feb 11, 2014)

Jim Pawloski said:


> I have 36247, 75726, 75774, 76377, 37204, 75894, 75898 for 2013 coding
> 
> HTH,
> Jim Pawloski, CIRCC



I agree with Jims code choices, except 76377. Perhaps he meant 76937 (u/s guidance)? But that code is bundled with 36247.

HTH


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## Jim Pawloski (Feb 11, 2014)

dpeoples said:


> I agree with Jims code choices, except 76377. Perhaps he meant 76937 (u/s guidance)? But that code is bundled with 36247.
> 
> HTH



No, I meant to bill for the CT spin.  Wrong code, but u/s vascular guidance is bundled into the catheterization?

Jim


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## dpeoples (Feb 12, 2014)

Jim Pawloski said:


> No, I meant to bill for the CT spin.  Wrong code, but u/s vascular guidance is bundled into the catheterization?
> 
> Jim



Sorry about that. Jim is correct in that 76937 does not bundle with 36247.

Jim, doesn't there need to be a base CT code to code 76377?


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## Jim Pawloski (Feb 12, 2014)

dpeoples said:


> Sorry about that. Jim is correct in that 76937 does not bundle with 36247.
> 
> Jim, doesn't there need to be a base CT code to code 76377?



I just received the SIR coding update, and the code for the CT, limited or localized follow-up is 76380.  76937 is for 3-d reconstruction.  My error.

Thanks,
Jim


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## margaret fahy (Feb 13, 2014)

*sma & Embo*

Guys,
I don't see the post embo angiography?
Can you point it out for me?
Margie


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## dpeoples (Feb 13, 2014)

margaret fahy said:


> guys,
> i don't see the post embo angiography?
> Can you point it out for me?
> Margie



75898.

Hth


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## Jim Pawloski (Feb 13, 2014)

dpeoples said:


> 75898.
> 
> Hth



Can't use 75898 with the new codes.  Bundled into them except for the cerebral embo. codes.

Jim


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## dpeoples (Feb 13, 2014)

Jim Pawloski said:


> Can't use 75898 with the new codes.  Bundled into them except for the cerebral embo. codes.
> 
> Jim



Date of service was in 2013.


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## margaret fahy (Feb 13, 2014)

*Sma angiography*

I mean...I do not see a post-embo angiography documented in report...was hoping you could point it out to me....i don't see it.


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## dpeoples (Feb 13, 2014)

margaret fahy said:


> I mean...I do not see a post-embo angiography documented in report...was hoping you could point it out to me....i don't see it.




So sorry, you are correct. There is no post embolization follow-up angiography documented (though I am sure they did one). 

sorry for the confusion...


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