# Bilateral Uterine Artery Angiogram and Embolization



## birky (Dec 7, 2010)

Can anyone help code the following?

PROCEDURE:
BILATERAL UTERINE ARTERY ANGIOGRAM AND EMBOLIZATION

HISTORY:
Patient delivered with C section and developed continuous arterial bleeding. That could not be stopped conservatively and/or with surgical management. Patient required blood transfusion.

CONSENT:
Procedure, risks, and benefits are explained to the patient. Informed consent was obtained.

Patient was positioned in comfortable supine position. Moderate sedation with Versed and Fentanyl was initiated. Hemodynamic monitoring was performed during sedation.

Using ultrasound guidance, the right common femoral artery was accessed without difficulty. A 5-French introducer was advanced into the right common femoral artery and was flushed with heparinized saline. A 4- French glide Cobra catheter was then used for selective selective catheterization of the contralateral left internal iliac artery using fluoroscopic guidance. Contrast was injected and left internal iliac artery angiogram was performed.

Selective catheterization of left uterine artery was performed with the 4-French Cobra catheter (3rd order branch). Then, a combination of 500 and 250 micron particles were injected into the left uterine artery. Embolization was performed. Stasis was achieved.

At the end of the left uterine artery embolize, patient started complaining of pelvic discomfort. At that point, a PCA pump was started with Dilaudid.

The catheter was then pulled back and selective catheterization of the ipsilateral right internal iliac artery was performed with a 5-French catheter. Contrast was injected and right internal iliac artery angiogram was obtained. The right uterine artery was identified and appeared larger than the left uterine artery.

At this point, coaxially, a 2.7-French microcatheter was advanced over a 0.014 inch wire and advanced into the right uterine artery. Then, embolization of the right uterine artery with Embosphere particles and Embozene particles measuring 500, 700, and 250 micron particles was performed. Stasis of the right uterine artery was noted at the end of the embolization.

The patient, overall, tolerated the procedure well. No complications were encountered. The catheters were removed and a right common femoral artery Angio-Seal was used to seal the access site in the femoral artery.

IMPRESSION:
SUCCESSFUL BILATERAL UTERINE ARTERY EMBOLIZATION.

Thanks for any suggestions on this, my brain is frozen.


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## kbazarte@yahoo.com (Dec 7, 2010)

The only code is 37210, it is a bundled code includes angio, cath selects, S&I and embolization wether uni or bilat


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## dpeoples (Dec 7, 2010)

birky said:


> Can anyone help code the following?
> 
> PROCEDURE:
> BILATERAL UTERINE ARTERY ANGIOGRAM AND EMBOLIZATION
> ...



CPT 37210 is for Embolization of Uterine Fibroids and does not apply here. This case should be coded out the old fashioned way, by each component:
37204/75894/75898
36247 LT /75736
36247 RT/ 75736

HTH


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## kbazarte@yahoo.com (Dec 7, 2010)

you are absolutely correct I was distracted by a co-worker and missed that it was for bleeding versus fibroids


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## birky (Dec 8, 2010)

Thanks for the help, it is greatly appreciated.


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