# Varicocele Embolization Coding Question



## lguidry (Jul 26, 2010)

Can someone please help me code the following Varicocele Embolization, I am struggling! Thanks!

Clinical Reason: VARICOCELE  

Interventional Radiology Consult: 

The patient is an 18-year-old male referred to me for possible treatment of a left-sided varicocele. The patient was initially seen by me on 02/17/10. I examined the patient at that time and there was mild swelling at the left hemiscrotum. I performed an ultrasound at that time that demonstrated a moderate sized left-sided varicocele. The patient has symptoms consisting of pain in the left groin which increases over time while standing for long periods of time. Swelling occurs after standing for long periods of time as well. The patient has no other medical history. The patient has no significant allergies. 

Physical examination. Mild swelling of the left hemiscrotum. 

Heart: Regular rate and rhythm without murmur. 

Lungs: Clear to auscultation. 

Abdomen: Soft with normal bowel sounds. 

Extremities: No cyanosis, clubbing or edema. 

Preoperative labs are within normal limits. 

Impression: 
1. Symptomatic left-sided varicocele. Benefits and risks of the procedure have been discussed with the patient and his family and informed consent was obtained. I will plan to embolize the left-sided varicocele from a right common femoral approach. 


Left Varicocele Embolization: 

Time out 

Correct patient identified yes 
Correct procedure verifiedyes 
Correct site identified and marked prior to procedureyes Location right groin 
Agreement on procedure to be doneyes 
Correct patient position yes 
Availability of special equipmentyes 

Informed consent was obtained prior to the procedure. The right groin was prepped and draped in a sterile fashion. Anesthesia was obtained with 1% lidocaine as well as conscious sedation. A 21-gauge needle was advanced into the right common femoral vein under ultrasound guidance. A vascular sheath was placed. Utilizing a 5 French Cobra catheter and hydrophilic wire, the left renal vein was selectively catheterized followed by the left internal spermatic vein. Digital subtraction venography of the internal spermatic vein during Valsalva demonstrated prompt reflex and a distended internal spermatic vein to the level of the pampiniform plexus. A parallel collateral vein was identified at the mid internal spermatic vein extending cephalad to the level of the left renal vein. A 3 French microcatheter was advanced through the 5 French Cobra catheter to the level of the acetabular roof. An 8 mm x 20 mm coil was placed in the internal spermatic vein. Subsequently, 5 cc of 3% sodium tetradecyl sulfate foam was injected following thrombosis of the vein. Subsequently, repeat venography at the midportion of the internal spermatic vein reidentified the large parallel collateral. A coil was placed just below this level. Subsequently additional 6 cc of 3% sodium tetradecyl sulfate foam was injected. Thrombus was identified to be forming within the vein and there was no further reflex identified. The patient only experienced mild discomfort within the left groin. The catheter and sheath were removed and hemostasis was achieved. The patient tolerated the procedure well and was observed for two hours prior to discharge in stable condition. 

Impression: 
1. Technically successful left-sided varicocele embolization. 
2. The patient was instructed to decrease activity for the next three days and then subsequently may resume normal activity. 
3. I instructed the patient to followup with me in two to three months. At that time, a repeat ultrasound of the scrotum will be performed to confirm improvement of the varicocele.


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