# 75774 - When the right hepatic artery is selected



## EikaMTGQueen (Jan 30, 2013)

When the right hepatic artery is selected and an arteriogram was performed would you code 75774? If so where is the medical necessity?

Thanks
Erica Ross CIRCC


Mesenteric arteriogram 1/25/2013

Impression:
1. Celiac: patent with aneurysm at bifurcation into the splenic and
the hepatic arteries.
2. SMA: patent
3. IMA: patent
4. Plan is for stent graft placement from celiac to proper hepatic
artery with stent grafting or embolization of the splenic artery at
CMC

History: Splenic artery aneurysm on noncontrast CT please evaluate.

Anesthesia:
1. 1% lidocaine.
2. Benadryl 25 mg IV.

Contrast: Isoview-250, 175 ml.
Approach: Right. common femoral artery.
Hemostasis: AngioSeal 
Estimated Blood Loss: Minimal. Fluoro time: 9.1 minutes.

Procedure: Informed consent was obtained. The risk benefits and
alternative procedures were discussed. The risk of hematoma, need for
vascular surgery, renal failure, and contrast reaction were discussed
along with potential benefits.

The right  groin was sterilely prepped and draped the skin was
anesthetized with lidocaine. The right  common femoral artery was
entered. The celiac, superior mesenteric artery, and inferior
mesenteric artery were selectively catheterized and mesenteric
arteriograms were performed.

Diagnostic angiography Indication:
1. No previous or adequate prior imaging is available and decision to
treat was made on current angiogram.

Other procedures: 
1. Super selective catheterization: The right hepatic artery was super
selectively catheterized. Hepatic arteriography was performed

Findings: 

Aortogram: Patent without focal stenosis.

Celiac: The celiac artery is patent. There is a 3 cm aneurysm at the
bifurcation of the celiac artery into the hepatic and splenic artery..
Delayed films show the splenic vein and portal vein to be widely
patent.

Superior mesenteric artery: The superior mesenteric artery is widely
patent at its origin. The jejunal, ileal colic, right colic branches
fill normally.  The venous phase shows the superior mesenteric vein to
be patent.

Inferior mesenteric artery: The IMA is widely patent. There is normal
filling of the left colic and superior hemorrhoidal artery.  Delayed
images show a patent inferior mesenteric vein.


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## kbazarte@yahoo.com (Feb 1, 2013)

From your report the codes you would use are as follows ) there is no dictation for the hepatic angio ):

32645 (select celiac ) 75726-26 (celiac angio )
36245-59 ( select sma ) 75726-26-59 ( sma angio )
36245-59 I select IMA ) 75726-26-59 (IMA angio )

If off the celiac he had selected the rt hepatic and also did an angio the codes off the celiac would change to the following:

36247 ( select rt hepatic ) 75726-26-59 ( celiac angio ) 75774-26 each additional after basic angio ( rt hepatic angio )

For the medical nessicity it would be the same mesenteric dx


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## Lynda Wetter (Feb 4, 2013)

Is this the statement being used for reasoning for the diagnostic portion of this procedure?


Diagnostic angiography Indication:
1. No previous or adequate prior imaging is available and decision to
treat was made on current angiogram.


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