# Embolization



## prabha (May 11, 2009)

Can we code this procedure with 

37204
36247
36248
75726-26
75894-26
75898-26

Using Seldinger technique, the right
common femoral artery was punctured and a 5 French sheath was placed into
the common femoral artery. Through the sheath, 5 French Cobra catheter
was used to catheterize the hepatic artery. Hepatic angiogram was
performed.
The angiogram revealed patent celiac axis, patent hepatic gastroduodenal
and splenic artery. The patient's left gastric artery is hypertrophied.
The portal vein is patent.
There is evidence of varices noted in the level of the GE junction.
On the hepatic angiogram, two hypervascular masses are noted. One is in
the right lobe, one is in the left lobe.
The third lesion that is seen on CT scan is not visualized on the
angiogram.
Superselective catheterization of the right hepatic artery was performed
with a renegade catheter. The catheter was placed proximal to the tumor
and embolization was performed with particles, ranging from 300 to 500
microns. Stasis was achieved.
The left hepatic artery is catheterized. However, adequate purchase could
not be made with a catheter into the artery supplying the tumor.
An accessory artery was then catheterized that also supplied the tumor.
But the accessory artery also supplied what appeared to be the caudate
lobe. The artery of the caudate lobe was first accessed and embolized
with coils to prevent any flow into the caudate lobe. Post-protection of
the caudate lobe, embolization was carried out of the left hepatic
lesion. Stasis was achieved in artery supplying the left hepatic lesion.
Angiogram was performed which revealed no evidence of flow to the
previously demonstrated tumors. There is again nonvisualization of the
third lesion that was seen on the CT scan.
IMPRESSION:  Visualization of only two of the tumors seen on the CT scan.
The third tumor is not visualized.
Successful embolization  of both tumors with particles ranging from 300
to 505 microns.


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## dhuston (May 13, 2009)

I don't see angiograms for the Rt and Lt hepatic arteries.  I do think they were done, I just don't see them documented.

Not sure where that accessory artery is coming from.  It may be another 36248 if you had more info.  Agree with your other codes.

Diane Huston, CPC,RCC


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## MLS2 (May 14, 2009)

true, they didn't mention the angio's done in the super selected arteries.  I'm so used to my physicians documentation...they always mention that
I do see a third order 36247(right hepatic) and an additional 3rd order (left hepatic) 36248.  The accessory is most likely another 3rd order but they should mention which accessory artery it is in order to code it.


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## prabha (May 15, 2009)

Thanks for your valuable inputs


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