# Uterine artery embolization



## elamathi (Jun 9, 2009)

Hi all,

Pls confirm the codes ..
75630
75736
36247
36248
75774
75774-59
37204
75894
36246-59
36248-59
75736-59
75774
75774-59
37204-59
75894-59
75898
75898-59
36247-59
75774-59
75774-59
It seems over-billed..75774*?
Indication:   Pelvic fracture and bleed.
PROCEDURE: After informed consent was obtained from available family members, the patient was brought to the angio suite and the right groin prepped and draped in the usual sterile fashion. Utilizing ultrasound guidance, percutaneous access was obtained into the right common femoral artery away from branch vessels. Following placement of a 5 French sheath, pigtail catheter was advanced to the level of the infrarenal abdominal aorta and a flush aortogram obtained. This demonstrated the vessels to be small with presumed vascular clamping secondary to the patients tenuous vascular status. There is no significant narrowing of the common iliac arteries bilaterally.
Utilizing various catheters, the left internal iliac artery was selectively catheterized. Following stabilization of the catheter within the internal iliac artery, gelfoam embolization was performed into both the anterior and posterior divisions. There is relatively initial stasis of flow into the branch vessels. At this time the catheter was withdrawn and selective catheterization of the right internal iliac artery performed. Following stabilization of the catheter within the right internal iliac artery, gelfoam embolization of both the anterior and posterior divisions was again performed on the right. There was limited filling of a anterior branch vessel after initial gelfoam embolization with further embolization performed. Gelfoam pledgets of approximately 2 mm by approximately 10 mm length torpedoes were placed. Repeat imaging on the left showed relative limited filling of branch vessels. There is narrowing noted in the left external iliac artery that may in part be related to spasm. Selective injection was ultimately performed at the level of proximal profunda system on the left for evaluation of collateral supply into the obturator foraminal region. No active bleeding was clearly identified though areas of vessel caliber change were noted. No embolization was performed at this time at this level. Catheter was withdrawn. Contrast injection was performed through the right common femoral sheath. A small filling defect was noted at the tip of the sheath likely representing a small amount of thrombus that had formed. Contrast injections showed the vessel diameter of the right external iliac artery to be small. No active bleeding was identified from proximal profunda branch vessels on the right. Delayed imaging did show partial filling of both internal iliac arteries without significant vascular opacification of the internal branch of iliac vessels on the right. There is mild filling of a small vessel noted on the left. At this time it was elected to terminate further intervention. Due to the small vessel caliber, the sheath was removed and hemostasis obtained utilizing standard manual compression.
IMPRESSION:
Status post bilateral internal iliac artery embolization with Gelfoam pledgets. Prophylactic embolization of both the anterior and posterior divisions was performed bilaterally with large pledgets utilized.


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## jtuominen (Jun 9, 2009)

Uterine Artery Embolizations (UAEs) are billed with one code only-- 37210. It includes "all catheterizations and intraprocedural imaging require for the procedure to confirm the presense of previsouly known fibroids and to map vascular anatomy to enable appropriate therapy." CPT Professional Edition p.180


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## Jenifer (Jun 9, 2009)

37210 is used for fibroid embolization.  If it's done for anything other than fibroids, use component coding, such as postpartum bleeding.


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## elamathi (Jun 10, 2009)

I just want to know the codes for catheterization.. as we all aware that the procedure was not for fibroid embolization to code 37210.

Any Insight would be appreciated


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## Kimberfly (Jun 10, 2009)

I don't see any diagnostic angios in the pelvis after the first "flush" aortogram. All of the imaging done after the embos is included in 75898 except for the area by the left profunda. Also, embolizations are only once per operative field. So, I would code this as:
37204
75894
75898
36247
36246-59
36248x2
75630
36248 for the injection by the left profunda
75774 for the study by the left profunda

The 75736 codes would only be used if the radiologist injected selectively and did angiography of the anterior and posterior divisions prior to embolizing. I don't see any of that beyond the flush.


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## dpeoples (Jun 10, 2009)

Kimberfly said:


> I don't see any diagnostic angios in the pelvis after the first "flush" aortogram. All of the imaging done after the embos is included in 75898 except for the area by the left profunda. Also, embolizations are only once per operative field. So, I would code this as:
> 37204
> 75894
> 75898
> ...





I concur with Kimberfly on all codes.


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## elamathi (Jun 11, 2009)

Hi,


Thank you so much.

Regds
Elamathi


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