# Embolization/Arteriography Help



## hwilcox07 (Jul 17, 2014)

Can I bill all of these codes for the following report?? Thanks in advance for any advice.

Catheterizations:
36245-59- SMA
36247     - GDA
36248     - Cystic
36248     - RHA
36248     - LHA

Arteriograms:
75726      -  SMA
75726-76 -  Celiac
75774      -  GDA
75774      -  Cystic
75774      -  RHA
75774     -  LHA
75710     -  RLE

37243     -  Embolization

(The MAA injections will be reported separately from Nuc Med)


ROENTGENOLOGICAL FINDINGS: 
XRAY SPECIAL PROCEDURE W/CONTRAST 
HISTORY: MAL NEO LIVER, PRIMARY 
PROCEDURES: SMA and celiac artery angiography, right lower extremity 
angiography, MinxGrip deployment, right and left hepatic artery shunt 
injections, cystic artery angiography and embolization and angiogram to 
check results, gastroduodenal artery angiography and embolization and 
angiogram to check results, right and left hepatic artery angiogram, and 
left gastric artery angiography. 
HISTORY: Hepatocellular carcinoma pre SIR-Sphere infusion/treatment. 
After extending the procedure, alternatives and risks, informed consent 
was given. 
The patient was placed in the supine position and the right groin was 
prepped. Using ultrasound guidance and a maximum sterile barrier, a single 
puncture was made. Serial dilatation was performed and a 6 French sheath 
inserted. Through this a Simmons 2 carrier catheter and a SOS catheter 
were used to perform the above angiogram. 
FINDINGS: 
RIGHT LOWER EXTREMITY ANGIOGRAPHY: 
The common iliac and external iliac arteries are widely patent. 
AORTOGRAM: 
Injection demonstrates normal renal arteries. There is a left-sided 
abdominal aortic aneurysm which measures 9.0 x 6.6 mm and is unchanged 
from previous CT exams dating back to 7/12/2012. 
SMA INJECTION: 
There is normal branching pattern to the SMA without evidence of replaced 
hepatic branch. 
Celiac artery injection: There is a normal splenic, left gastric, right 
and left hepatic arteries and gastroduodenal branches. The hepatic 
arterial tree is slightly small but tumor nodules are seen on delayed 
imaging over the liver. 
LEFT HEPATIC ARTERIAL INJECTION: 
Study demonstrates multiple tumor vessels with a blush seen over the 
central left lobe of the liver. Slight irregularity is seen but no branch 
is noted to the stomach. 
FIRST SHUNT SITE INJECTION: 
The first injection of the technetium 99m MAA was performed at this site. 
GASTRODUODENAL ARTERY ANGIOGRAPHY AND EMBOLIZATION AND ANGIOGRAM TO CHECK 
RESULTS: 
Angiogram demonstrates normal anatomical path to the gastroduodenal 
artery. Normal flow is seen. No endoluminal thrombus. Gastroduodenal 
artery was entered. A series of interlock coils were deployed up to the 
margin of the artery without evidence of problem. 
ANGIOGRAM TO CHECK RESULTS: 
Repeat carrier catheter injection demonstrates excellent positioning of 
the endovascular coils without significant flow. 
CYSTIC ARTERY ANGIOGRAPHY EMBOLIZATION AND ANGIOGRAM TO CHECK RESULTS: 
The cystic artery was cannulated and injection demonstrates normal 
branches over the margin of the gallbladder. Minimal blush by the 
gallbladder fossa. Subsequently, a single 2 x 6 mm vortex interlock coil 
was deployed. Repeat injection demonstrated minimal antegrade flow but 
this should be adequate. 
RIGHT HEPATIC ARTERY ANGIOGRAPHY: 
Study demonstrates at least five separate tumor nodules in the right lobe 
of the liver. Normal size hepatic branches are seen otherwise. No colonic 
collateral. 
SECOND SHUNT SITE INJECTION: 
The second half of the technetium 99m MAA was injected at this site 
without problem. 
LEFT GASTRIC ARTERY ANGIOGRAPHY: 
Injection demonstrates normal left gastric branches. There is a tiny 
collateral to the right half of the liver but no connection to the hepatic 
arterial tree as best can be discerned. 
MinxGrip was deployed. Orders written. No evidence of immediate post 
procedure complication. Patient should be ready for SIR-Sphere infusion. 
IMPRESSION: 
Successful embolization of gastroduodenal artery and the cystic artery. 
Successful right and left hepatic arterial branch shunt injections. 
Multiple enhancing intrahepatic tumors. Small stable aneurysm left side of 
the aorta. 
No evidence of immediate post procedure complication. 
FLUOROSCOPIC TIME: 14.4 minutes. 
TIMEOUT: Observed.


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## Jim Pawloski (Jul 23, 2014)

hwilcox said:


> Can I bill all of these codes for the following report?? Thanks in advance for any advice.
> 
> Catheterizations:
> 36245-59- SMA
> ...



I agree with what you coded.
Thanks,
Jim Pawloski, CIRCC


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## hwilcox07 (Jul 24, 2014)

Thanks Jim!


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