# embolization - Can any one confirm my codes



## Shirleybala (Apr 20, 2009)

Hello:
Can any one confirm my codes 
Lumbar Arteries
36245 
36245-59
75705
75705-59
Aortogram
75630

Internal iliacs
36247
75736
75774
36245-59
75736-59

embolization:
37204
75894
75898

Aortogram, pelvic arteriogram and embolization:
Clinical history: Trauma.
On an emergent basis, the patient was brought to the Interventional
Radiology Department.  The patient's right groin was prepped and draped
in the usual sterile fashion.  Several attempts at identifying the right
common femoral artery under ultrasound were unsuccessful.  The patient's
left groin was, therefore, prepped and draped in the usual sterile
manner.   The patient's left common femoral artery was punctured and a
vascular sheath was placed.  Over a guide wire, a catheter was advanced
into the abdominal aorta and contrast injection was performed revealing
the abdominal aorta to be patent and normal in caliber.  The left common
iliac, external iliac and internal iliac artery are visualized without
definite evidence of extravasation.  Diminished flow within the right
common and external iliac artery was visualized.
Selective catheterization of several lumbar arteries was achieved.
Contrast injection was performed revealing no definite evidence of active
extravasation from any of the visualized right-sided lumbar arteries.
The catheter was exchanged and selective catheterization of the right
common iliac and subsequently internal iliac artery was achieved.
Contrast  injection was performed revealing abrupt termination of the
anterior and posterior divisions of the internal iliac artery.  Several
attempts at advancing a guide wire into the distal portions were
unsuccessful.  Given the appearance on the patient's prior CT scan and
the abrupt termination of the vessels, avulsion of the vessels was
suspected and,  therefore, a Gelfoam slurry embolization of the internal
iliac artery on the right was performed.
The catheter was withdrawn and contrast injection repeated revealing no
evidence of active extravasation.  A branch vessel originating from the
internal iliac artery leading into the region of the right flank was
identified which also demonstrated abrupt termination but led to the site
of the patient's large right flank hematoma.  Subselective
catheterization of this vessel with a microcatheter was achieved.
Contrast injection was performed revealing this to be the source of the
large flank hematoma.  Coil embolization of this vessel with 2 and 3 mm
coils was achieved.The catheter was then repositioned into the right external iliac artery
and contrast injection was performed revealing abrupt termination of the
external iliac artery at the level of the femoral head.  The common
femoral artery was not visualized.
The catheter was withdrawn and selective catheterization of the left
internal iliac artery was achieved.  Contrast injection revealed no
evidence of extravasation from the left side.
The catheter was removed and the vascular sheath was left in place and
secured to the skin.
The patient tolerated the procedure without evidence of  immediate
complication.


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## MLS2 (Apr 20, 2009)

I would ask for clarification on how many lumbar arteries were selected and also what the name of the branch was that was "subselected" off of the internal iliac on the right.  The right internal would be a 2nd order from the left groin puncture, was the additional vessel another 2nd order? 3rd order?


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## dhuston (Apr 20, 2009)

Here's what I got from it:

For the lumbar arteries I would only code 36245 x2 and 75705 x2 unless you can get info on the exact number and an addendum would be good to specifically identify them in case an appeal is needed.

75630 aortogram and runoff

Rt Int Iliac branch 36247
Rt Ext Iliac 36248
Lt Int Iliac 36245

75736 x2 for the interal iliac angiograms
75774 for the Rt Int Iliac branch angiogram
75710 or 75774 for the Rt Ext Iliac angiogram (not sure if 75710 is bundled and don't have access to cci edit)

37204
75894
75898

Diane Huston, CPC,RCC


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