# Help with CPT code- Percutaneous Coiling of Hypogastric Artery



## Ally718 (Dec 23, 2019)

Hello,

I'm having trouble choosing the correct CPT code for this OP report. I'm stuck between 37242 and 34702. Any assistance would be greatly appreciated. 

PREOPERATIVE DIAGNOSIS:  LEFT INTERNAL ILIAC ARTERY ANEURYSM.

POSTOPERATIVE DIAGNOSIS:  LEFT INTERNAL ILIAC ARTERY ANEURYSM.

OPERATION:
1.  AORTOGRAM.
2.  PERCUTANEOUS COILING OF LEFT HYPOGASTRIC ARTERY BRANCHES USING 4 
TERUMO COILS.
3.  PLACEMENT OF 11 X 10 VIABAHN STENT IN THE LEFT HYPOGASTRIC ARTERY.
4.  PERCLOSE X2.


ANESTHESIA:  GENERAL.

COMPLICATIONS:  NONE.
ESTIMATED BLOOD LOSS:  100 ML.
WOUND CLASSIFICATION:  CLEAN.
PATIENT CONDITION TO POSTANESTHESIA CARE UNIT:  STABLE.

INDICATIONS FOR PROCEDURE:
This is a 72-year-old male with a history of left hypogastric and artery
aneurysm seen on CT for nephrolithiasis including asymptomatic as had 
been growing on subsequent CT scans.  He was offered endovascular 
repair.  Informed consent was obtained.


PROCEDURE:
The patient was correctly identified in the preoperative holding area.  
The correct surgical site was marked.  He was brought to the operating 
room in stable condition, attached to cardiac monitors, and induced 
under general anesthesia.  A right radial arterial line was placed as 
well as a Foley catheter at the bilateral groins and the abdomen was 
prepped and draped in the usual sterile fashion.  Surgical timeout was 
performed.  No concerns were raised at that time.

Using ultrasound and fluoroscopic guidance, the right common femoral 
artery was punctured using micropuncture technique and upsized to a 
5-French diagnostic sheath using standard technique.  A wire and 
catheter were advanced into the abdominal aorta performing an aortogram 
revealing no significant stenosis with very narrow distal aorta.

A standard up-and-over technique was obtained using Contra catheter and 
Glidewire, and the left hypogastric artery was selected using Glidewire 
Advantage.  The 5-French sheath was then exchanged over a wire for a 
long 7-French sheath and the patient was given systemic heparin.  There 
were noted to be 2 small branches on the medial aspect of the 
hypogastric artery that appeared to be feeding onto the aneurysm sac 
which was about 2.8 x 3.7 cm in size.  Decision was made to selectively 
cannulate these and perform coil embolization.  This was done using 4 
Terumo coils, 2 of the 2 x 2 mm size coils, and 2 of the 2 x 4 mm coils.
 Post-coil angiography revealed no filling of these branches.

Decision was made at this time to cover the aneurysm of the hypogastric 
artery using a Viabahn stent measuring 11 x 10 in size.  For this to 
occur, we had to upsize our sheath from 7-French to a 12-French sheath. 
Initially, this proved difficult as it was not tracking over the aortic 
bifurcation.  We were able to finally traverse this using the 7-French 
within the 12-French sheath.

Once our wire was in place, we performed one last shot to see exactly 
where we wanted to deploy our stent and then moved our Viabahn stent 
into position.  Post-deployment angiography revealed no endoleak at the 
time with patent vasculature proximally and distally, and no evidence of
any crumpling of the stents.  The catheters and sheath were pulled back 
to the level of the abdominal aorta.  The patient was given protamine to
reverse.  The sheath was then removed over the wire and then 2 Perclose 
devices were used in the right common femoral artery.

After deploying the Perclose and holding manual pressure, the groin was 
found to be hemostatic and a 4-0 Monocryl was used to close the skin.  
Sterile dressing was placed using sterile OpSite.  The patient tolerated
the procedure well, aroused from anesthesia without difficulty.  
Surgical sponge and sharp counts were correct at the end of the case.  
The patient had Dopplerable signals and bilateral dorsalis pedis and 
posterior tibial arteries at the end of the case which were baseline.


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## arclayton (Jan 1, 2020)

I would report 37242, 36246 & G0269 for the embolization of the iliac artery. According to Dr Z: if both coils and a stent are placed to embolize a single site, only submit the appropriate embolization code (37241-37244), not a stent code. The physician knew exactly where the aneurysm was because of the prior CT so I would not add the imaging.


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## Jim Pawloski (Jan 2, 2020)

G0269 is billed for hospital only, not physician


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## ernist8489 (Feb 15, 2020)

Jim Pawloski said:


> G0269 is billed for hospital only, not physician


My thoughts exactly.


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## ernist8489 (Feb 15, 2020)

ernist8489 said:


> My thoughts exactly.


We would code this case-37242, 36247, 36248, (+)76937.
2 seperate branches from the 2nd order LT Hypogastric were "selectively" cannulated followed by the coil placement. Those would both be 3rd or higher vessels so 36247 for the 1st and 36248 in addition. 
Ultrasound guidance for access was used this we may report 76937.

Erik Brown, CIRCC,CPC


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## jadhavganesh345@gmail.com (Feb 17, 2020)

we would code 37242, 36247, 36248
To code 76937 requires documentation of ultrasound guidance for evaluation of potential access sites, selected vessel patency, and realtime visualization of vascular needle entry. Also requires permanent recording and reporting in the documentation.


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## Ally718 (Feb 18, 2020)

Thank you all!!


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